From the Guidelines
Chronic Obstructive Pulmonary Disease (COPD) Type A, also known as emphysema, is primarily caused by long-term exposure to cigarette smoke and should be treated with smoking cessation as the most effective intervention, along with personalized pharmacologic therapy and pulmonary rehabilitation. The causes of COPD Type A are multifactorial, including:
- Long-term exposure to cigarette smoke
- Air pollution
- Occupational dust and chemicals
- Genetic factors, particularly alpha-1 antitrypsin deficiency Treatment of COPD Type A focuses on reducing symptoms, improving quality of life, and slowing disease progression, with the following key components:
- Smoking cessation, which is the most effective intervention, as emphasized by 1
- Pharmacologic therapy, including:
- Bronchodilator medications, such as short-acting beta-agonists like albuterol (2 puffs every 4-6 hours as needed) and long-acting agents like salmeterol (50 mcg twice daily) or tiotropium (18 mcg once daily)
- Inhaled corticosteroids, like fluticasone (250-500 mcg twice daily), for patients with frequent exacerbations
- Pulmonary rehabilitation programs, which combine exercise training, nutrition counseling, and education, as recommended by 1
- Oxygen therapy, for patients with severe hypoxemia (oxygen saturation below 88%), typically used for at least 15 hours daily
- Vaccination against influenza and pneumococcal disease, to prevent respiratory infections, as advised by 1 These treatments work by reducing airway inflammation, improving airflow, strengthening respiratory muscles, and preventing further lung damage, though they cannot reverse the structural changes in the lungs characteristic of emphysema, as noted by 1 and 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Causes of COPD Type A
- COPD is a respiratory disorder characterized by largely irreversible changes in air flow due to irritants such as tobacco smoke 2
- Eliminating exposure to cigarette smoke and other irritants, such as workplace irritants, is the only measure known to improve the outcome of COPD 2
Treatments of COPD Type A
- Regular medication is not necessary for patients who do not have recurrent symptoms 2
- Inhaled short-acting beta-2 agonists can improve dyspnoea 2
- Long-acting beta-2 agonists, such as salmeterol and formoterol, can reduce breathlessness and acute exacerbations 2
- Tiotropium, an inhaled long-acting antimuscarinic bronchodilator, has symptomatic efficacy in COPD, reducing dyspnoea and acute exacerbations 2, 3, 4
- Combination of an antimuscarinic with an inhaled beta-2 agonist can improve symptoms in 7% to 10% of patients 2
- In patients with one or two COPD exacerbations per year, adding an inhaled corticosteroid to a long-acting beta-2 agonist can prevent about 1 exacerbation during 3 to 4 years of treatment 2
- Long-acting β2-agonist (LABA)/long-acting muscarinic antagonist (LAMA) combination therapy is recommended over LABA or LAMA monotherapy in patients with COPD and dyspnea or exercise intolerance 5
Treatment Approach
- Treatment should be adapted to symptoms and the frequency of exacerbations 2
- A short-acting beta-2 agonist should be tried first, then replaced by an inhaled long-acting bronchodilator, or possibly tiotropium, when its effect is too short-lived 2
- An inhaled corticosteroid can be added if symptoms persist or exacerbations are frequent 2