From the Guidelines
The recommended inhaler treatment for COPD is LABD maintenance therapy in all symptomatic patients, with single inhaler dual therapy LABD in those with moderate to severe dyspnea and/or poor health status, and a step up to single-inhaler triple therapy in those with persistent moderate to severe dyspnea and/or poor health status despite treatment with single inhaler dual therapy with LAMA/LABA or ICS/LABA, as suggested by the 2023 Canadian Thoracic Society guideline 1.
Key Considerations
- The treatment approach should focus on alleviating symptoms, preventing exacerbations, and reducing mortality.
- Single inhaler dual therapy with LABD is recommended for patients with moderate to severe dyspnea and/or poor health status.
- Single-inhaler triple therapy should be considered for patients with persistent moderate to severe dyspnea and/or poor health status despite treatment with single inhaler dual therapy.
- The 2023 Canadian Thoracic Society guideline 1 provides the most recent and highest quality evidence for COPD management, superseding previous guidelines such as the 2015 American College of Chest Physicians and Canadian Thoracic Society guideline 1.
Treatment Options
- LABD maintenance therapy: recommended for all symptomatic patients with COPD confirmed by spirometry.
- Single inhaler dual therapy LABD: recommended for patients with moderate to severe dyspnea and/or poor health status.
- Single-inhaler triple therapy: recommended for patients with persistent moderate to severe dyspnea and/or poor health status despite treatment with single inhaler dual therapy.
Important Notes
- Proper inhaler technique is crucial for medication effectiveness.
- Patients should be regularly assessed for technique, adherence, and response to treatment.
- Treatment should be individualized based on symptom severity, exacerbation history, and patient preference.
From the FDA Drug Label
TUDORZA® PRESSAIR® (aclidinium bromide inhalation powder) is indicated for the maintenance treatment of patients with chronic obstructive pulmonary disease (COPD). The recommended dose of TUDORZA PRESSAIR is one oral inhalation of 400 mcg, twice daily (morning and evening approximately 12 hours apart)
The recommended inhaler treatment for a patient with Chronic Obstructive Pulmonary Disease (COPD) is TUDORZA PRESSAIR (aclidinium bromide inhalation powder) at a dose of 400 mcg, twice daily 2.
- Key points:
- Maintenance treatment: TUDORZA PRESSAIR is intended for the maintenance treatment of COPD.
- Dosage: The recommended dose is one oral inhalation of 400 mcg, twice daily.
- Administration: The inhaler should be used in the morning and evening, approximately 12 hours apart.
From the Research
Recommended Inhaler Treatment for COPD
The recommended inhaler treatment for a patient with Chronic Obstructive Pulmonary Disease (COPD) includes:
- Long-acting muscarinic antagonists (LAMAs) and long-acting β2-agonists (LABAs) in combination, which is currently the mainstay of treatment for COPD 3, 4, 5
- Inhaled corticosteroids (ICS) may be added to LABA/LAMA in patients with a history of frequent/severe exacerbations and high blood eosinophil counts, or in those with concomitant asthma 3
Treatment Guidelines
Treatment guidelines recommend the following:
- LABA/LAMA combination as the initial maintenance therapy option for symptomatic patients with low exacerbation risk and severe breathlessness or patients with severe symptoms who are at risk of exacerbations 5
- LAMA/LABA treatment leads to greater improvements in lung function and symptoms than LAMA monotherapy or ICS/LABA treatment 5
- Aclidinium/formoterol, a LAMA/LABA dual bronchodilator, has been shown to reduce disease burden in patients with COPD, including those that are treatment-naïve, without a significant increase in safety risk compared with monotherapies 6
Combination Therapy
Combination therapy with long-acting beta 2-adrenoceptor agonists or tiotropium bromide may be justified for patients with COPD, as these drugs have distinct and complementary pharmacological actions in the airways 7
- Combined use of an inhaled LABA with tiotropium bromide should provide important therapeutic benefits, although clinical trials of this combination have not been performed 7