From the Guidelines
The most effective treatment to reduce cough in COPD is a combination of bronchodilators, such as long-acting muscarinic antagonists (LAMAs) and long-acting beta-agonists (LABAs), with or without inhaled corticosteroids (ICS), as they have been shown to improve lung function, reduce symptoms, and decrease exacerbations 1.
Treatment Options
- Bronchodilators:
- Long-acting muscarinic antagonists (LAMAs) like tiotropium (18 mcg once daily)
- Long-acting beta-agonists (LABAs) like salmeterol (50 mcg twice daily)
- Inhaled corticosteroids (ICS) like fluticasone (250-500 mcg twice daily) for patients with frequent exacerbations
- Phosphodiesterase-4 inhibitors like roflumilast for patients with severe to very severe COPD and a history of exacerbations
- Mucolytics such as N-acetylcysteine (600 mg daily) to help thin mucus and make it easier to clear airways
Non-Pharmacological Approaches
- Smoking cessation to reduce airway irritation and worsening of cough
- Pulmonary rehabilitation to improve overall lung function
- Adequate hydration to keep secretions thin
- Avoiding triggers like air pollution, strong odors, and cold air to prevent cough exacerbation
Important Considerations
- Regular assessment of inhaler technique is necessary to ensure proper medication delivery 1
- Individualized treatment plans should be guided by the severity of symptoms, risk of exacerbations, side effects, comorbidities, drug availability and cost, and the patient’s response, preference, and ability to use various drug delivery devices 1
From the FDA Drug Label
The recommended dosage for patients with COPD is 1 inhalation of Wixela Inhub® 250/50 twice daily, approximately 12 hours apart. Roflumilast and its active metabolite (roflumilast N-oxide) are selective inhibitors of phosphodiesterase 4 (PDE4). Roflumilast 500 mcg has not been studied in hepatically impaired patients
- COPD Treatment: Wixela Inhub is indicated for the twice-daily maintenance treatment of airflow obstruction in patients with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and/or emphysema.
- Roflumilast Mechanism: Roflumilast and its active metabolite (roflumilast N-oxide) are selective inhibitors of phosphodiesterase 4 (PDE4), which leads to accumulation of intracellular cyclic AMP.
- Dosage: The recommended dosage for patients with COPD is 1 inhalation of Wixela Inhub 250/50 twice daily, approximately 12 hours apart. Roflumilast is administered as 500 mcg oral once daily. The best treatments to reduce cough in Chronic Obstructive Pulmonary Disease (COPD) include Wixela Inhub and roflumilast, as they can help reduce symptoms of COPD, including cough 2 3.
From the Research
Treatments to Reduce Cough in COPD
To reduce cough in Chronic Obstructive Pulmonary Disease (COPD), several treatments can be considered:
- Bronchodilators: These are the mainstay of pharmacological treatment for stable COPD, including β2-agonists and muscarinic antagonists 4.
- Combination therapy: The combination of salmeterol/fluticasone propionate and tiotropium bromide has been shown to be effective in preventing exacerbations and improving health status in severe and very severe COPD 5.
- Triple therapy: The combination of salmeterol/fluticasone propionate and tiotropium bromide has been shown to be superior to individual components in moderate to severe COPD, with improvements in lung function, symptoms, and quality of life 6, 7.
Specific Medications
Some specific medications that have been studied for their effectiveness in reducing cough in COPD include:
- Tiotropium bromide: A long-acting antimuscarinic bronchodilator (LAMA) that has been shown to be effective in reducing exacerbations and improving lung function in COPD 5, 4.
- Salmeterol/fluticasone propionate: A combination of a long-acting β2-agonist and an inhaled corticosteroid that has been shown to be effective in reducing exacerbations and improving health status in COPD 5, 6, 7.
Goals of COPD Treatment
The goals of COPD treatment include recognizing the impact of both symptoms and exacerbations on patients' lives, and considering optimal patient-focused management 8. This may involve a combination of pharmacologic and non-pharmacologic approaches, as well as monitoring treatment outcomes and adjusting management strategies accordingly.