What are the latest treatments for Chronic Obstructive Pulmonary Disease (COPD)?

From the Guidelines

The latest treatment for COPD involves a stepwise approach based on symptom severity and exacerbation risk, with a focus on bronchodilators, including long-acting beta-agonists (LABAs) and long-acting muscarinic antagonists (LAMAs), as the cornerstone of treatment, as recommended by the 2023 Canadian Thoracic Society guideline on pharmacotherapy in patients with stable COPD 1. The treatment approach for COPD is guided by the patient's symptom burden, health status, and risk of exacerbations. For most patients, treatment begins with bronchodilators, specifically:

• Short-acting beta-agonists (SABAs) like albuterol or short-acting muscarinic antagonists (SAMAs) like ipratropium for mild, intermittent symptoms, as supported by the global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease 2017 report 1.
• Long-acting bronchodilators, including LABAs such as salmeterol, formoterol, or indacaterol, and LAMAs like tiotropium, umeclidinium, or glycopyrronium, as recommended by the 2018 GOLD report 1. For patients with persistent symptoms or frequent exacerbations, combination therapy with LABA+LAMA (such as Anoro Ellipta or Stiolto Respimat) is recommended, as it has been shown to improve lung function, reduce symptoms, and decrease exacerbation rates 1. In cases with continued exacerbations or elevated eosinophil counts, inhaled corticosteroids (ICS) may be added, creating triple therapy (LABA+LAMA+ICS), although the benefits and risks of this approach should be carefully considered, as noted in the 2018 Mayo Clinic Proceedings article 1. Additional treatments for severe cases include:
• Roflumilast (a PDE4 inhibitor) for patients with chronic bronchitis and frequent exacerbations, as recommended by the 2018 GOLD report 1.
• Azithromycin (250mg daily or 500mg three times weekly) as preventive therapy for frequent exacerbators, as supported by the 2018 Mayo Clinic Proceedings article 1.
• Oxygen therapy for those with significant hypoxemia, as a crucial component of comprehensive COPD management, as emphasized in the 2023 Canadian Thoracic Society guideline 1. These medications work by relaxing airway muscles, reducing inflammation, and improving airflow, ultimately decreasing symptoms and exacerbation frequency while improving quality of life, as highlighted in the 2023 Canadian Thoracic Society guideline on pharmacotherapy in patients with stable COPD 1.

From the FDA Drug Label

1. 2 Maintenance Treatment of Chronic Obstructive Pulmonary Disease Wixela Inhub® 250/50 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.
2. 1 Maintenance Treatment of COPD STIOLTO RESPIMAT is a combination of tiotropium bromide and olodaterol indicated for long-term, once-daily maintenance treatment of patients with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and/or emphysema

The latest treatments for Chronic Obstructive Pulmonary Disease (COPD) include:

• Wixela Inhub® 250/50: twice-daily maintenance treatment of airflow obstruction in patients with COPD, including chronic bronchitis and/or emphysema.
• STIOLTO RESPIMAT: once-daily maintenance treatment of patients with COPD, including chronic bronchitis and/or emphysema. These treatments are used to reduce exacerbations of COPD in patients with a history of exacerbations 2, 3.

From the Research

Latest Treatments for Chronic Obstructive Pulmonary Disease (COPD)

• The latest treatments for COPD include long-acting anticholinergics, such as tiotropium, or long-acting beta 2-agonists as maintenance therapy 4.
• Fixed-dose combinations (FDCs) of a long-acting beta2-agonist (LABA) plus a long-acting muscarinic antagonist (LAMA) delivered via a single inhaler are approved for the treatment of COPD 5.
• Tiotropium bromide was the first LAMA available for COPD in clinical practice and is administered once daily 6.
• The combination of tiotropium and olodaterol, a LAMA and a LABA, respectively, is recommended as an initial and follow-up treatment choice in patients with COPD 7.

Treatment Options

• Long-acting muscarinic receptor antagonists (LAMA) such as tiotropium, glycopyrronium, and umeclidinium bromide are administered once daily 8.
• Long-acting β2-adrenoreceptor agonists (LABA) such as indacaterol, salmeterol, and formoterol are also used to treat COPD 8.
• LAMA/LABA fixed dose combinations (FDCs) provide the convenience of two bronchodilators with different mechanisms of action in a single inhaler 8.

Efficacy of Treatments

• Tiotropium has been shown to be safe and efficacious as a long-term, once-daily LAMA for the maintenance treatment of COPD and for reducing COPD exacerbations 6.
• The combination of tiotropium and olodaterol has been shown to reduce the risk of exacerbations and improve lung function and quality of life in patients with COPD 7.
• Once-daily LABA/LAMA FDCs have been shown to improve lung function and health-related quality of life in patients with mild-to-moderate COPD 5.