From the Guidelines
Inhalers recommended for managing chronic bronchitis include a combination of a long-acting muscarinic antagonist (LAMA) and a long-acting beta-agonist (LABA), with the option to add an inhaled corticosteroid (ICS) for patients with frequent exacerbations, as supported by the most recent evidence 1. The management of chronic bronchitis involves the use of inhalers to control symptoms and reduce exacerbations.
Key Medications
- Long-acting bronchodilators such as tiotropium (Spiriva) or umeclidinium (Incruse Ellipta) provide sustained relief for 12-24 hours and should be taken daily.
- Inhaled corticosteroids like fluticasone (Flovent) or budesonide (Pulmicort) help reduce airway inflammation and are typically used twice daily.
- Combination inhalers containing both a LAMA and a LABA, such as umeclidinium/vilanterol (Anoro Ellipta), offer convenience and enhanced efficacy for moderate to severe cases.
Proper Use and Technique
Proper inhaler technique is crucial for medication effectiveness—patients should fully exhale before inhaling the medication deeply and holding their breath for 5-10 seconds. Regular use as prescribed is essential, even when symptoms improve, as these medications manage but don't cure chronic bronchitis.
Rationale
These medications work by either relaxing airway muscles to improve airflow (bronchodilators) or reducing inflammation in the airways (corticosteroids), addressing the underlying pathophysiology of chronic bronchitis, as indicated by the global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease 1.
Additional Considerations
For patients with severe to very severe COPD and a history of exacerbations, a phosphodiesterase-4 inhibitor like roflumilast may be considered to reduce moderate and severe exacerbations, despite its potential side effects 1. However, the use of oral glucocorticoids is not recommended for chronic daily treatment of COPD due to the lack of benefit and high rate of systemic complications 1. Antibiotics like azithromycin may be used to reduce exacerbations in select patients, but their use should be cautious due to the risk of bacterial resistance and other side effects 1. Mucolytic agents like N-acetylcysteine may also be considered to reduce exacerbations in certain populations 1.
From the FDA Drug Label
In two (2) of the 3 clinical trials primarily designed to evaluate the efficacy of fluticasone propionate and salmeterol inhalation powder on lung function were conducted in 1,414 subjects with COPD associated with chronic bronchitis The trials were randomized, double-blind, parallel-group, 24-week treatment duration One (1) trial evaluated the efficacy of fluticasone propionate and salmeterol inhalation powder 250 mcg/50 mcg compared with its components fluticasone propionate 250 mcg and salmeterol 50 mcg and with placebo Improvements in lung function (as defined by predose and postdose FEV1) were significantly greater with fluticasone propionate and salmeterol inhalation powder than with fluticasone propionate, salmeterol, or placebo
The recommended inhaler for managing chronic bronchitis is fluticasone propionate and salmeterol inhalation powder. This inhaler has been shown to improve lung function in patients with COPD associated with chronic bronchitis. The recommended dosage is 250 mcg/50 mcg or 500 mcg/50 mcg, twice daily. 2
From the Research
Recommended Inhalers for Chronic Bronchitis
The following inhalers are recommended for managing chronic bronchitis:
- Long-acting muscarinic antagonists (LAMAs) such as tiotropium bromide, aclidinium bromide, and glycopyrrolate bromide 3
- Long-acting beta-agonists (LABAs) such as salmeterol 4
- Phosphodiesterase 4 inhibitors such as roflumilast 5
- Combination therapy of LAMAs and LABAs, such as tiotropium and salmeterol 4
Benefits of Recommended Inhalers
The benefits of these inhalers include:
- Improved lung function 4, 3
- Reduced exacerbation frequency 5, 4
- Improved symptom control 3, 6
- Reduced risk of mortality 7
Characteristics of Ideal Inhalers
An ideal inhaler for chronic bronchitis should have the following characteristics: