From the Guidelines
The treatment for wheezing in severe COPD primarily involves bronchodilators, with short-acting beta-agonists (SABAs) like albuterol providing immediate relief, and long-acting bronchodilators serving as maintenance therapy, with a combination of long-acting beta-agonists (LABAs) and long-acting muscarinic antagonists (LAMAs) recommended for severe COPD, as supported by the 2017 Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease report 1.
Key Components of Treatment
- Short-acting beta-agonists (SABAs) like albuterol for immediate relief
- Long-acting bronchodilators, including LABAs and LAMAs, for maintenance therapy
- Inhaled corticosteroids (ICS) for patients with frequent exacerbations, typically in combination with LABAs
- Systemic corticosteroids and antibiotics during acute exacerbations
- Oxygen therapy for patients with hypoxemia
Maintenance Therapy
For severe COPD, a combination of LABAs and LAMAs is recommended, with the addition of ICS for patients with frequent exacerbations, as shown in the 2017 GOLD executive summary 1 and further supported by the evidence on anti-inflammatory therapy in stable COPD 1.
Acute Exacerbations
During acute exacerbations, systemic corticosteroids and antibiotics may be necessary, with the goal of minimizing the negative impact of the current exacerbation and preventing subsequent events, as outlined in the 2017 GOLD report 1.
Comprehensive Management
Pulmonary rehabilitation, smoking cessation, and vaccination against respiratory infections are also crucial components of comprehensive COPD management, addressing the overall health and well-being of the patient, in addition to the specific treatment of wheezing and exacerbations, as emphasized in the management guidelines 1.
From the FDA Drug Label
If shortness of breath occurs in the period between doses, an inhaled, short-acting beta2-agonist should be taken for immediate relief The treatment for wheezing in severe Chronic Obstructive Pulmonary Disease (COPD) is to use an inhaled, short-acting beta2-agonist for immediate relief, in addition to the prescribed maintenance treatment with Wixela Inhub® 250/50 twice daily 2.
- The recommended dosage for patients with COPD is 1 inhalation of Wixela Inhub® 250/50 twice daily, approximately 12 hours apart.
- Wixela Inhub® is not indicated for the relief of acute bronchospasm.
From the Research
Treatment for Wheezing in Severe COPD
The treatment for wheezing in severe Chronic Obstructive Pulmonary Disease (COPD) typically involves the use of inhaled long-acting bronchodilators, such as long-acting muscarinic antagonists (LAMAs) and long-acting beta2 agonists (LABAs) 3.
- LAMA/LABA Combinations: Four fixed-dose combinations of a LAMA with a LABA are now available, all indicated as maintenance bronchodilator treatment to relieve symptoms in adult patients with COPD 3.
- Pharmacologic Management: The American Thoracic Society recommends the use of long-acting β2-agonist (LABA)/long-acting muscarinic antagonist (LAMA) combination therapy over LABA or LAMA monotherapy in patients with COPD and dyspnea or exercise intolerance 4.
- Comparison of LAMA+LABA and LABA+ICS: A systematic review found that LAMA+LABA combination therapy probably holds similar benefits to LABA+ICS for exacerbations and quality of life, but offers a larger improvement in FEV1 and a slightly lower risk of pneumonia 5.
- Role of ICS/LABA Fixed-Dose Combinations: Fixed-dose combinations of ICS/LABA are commonly prescribed for both asthma and COPD, with fluticasone propionate (FP) and salmeterol forming a cornerstone of many treatment plans 6.
- Long-acting Beta-agonists: Long-acting beta-agonists (LABAs) have been licensed for the treatment of COPD since the late 1990s and include formoterol and salmeterol, which improve lung function, symptoms of breathlessness and exercise limitation, health-related quality of life, and may reduce the rate of exacerbations 7.