From the Guidelines
The most effective treatment for chronic cough in COPD is 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 a history of exacerbations, as recommended by the 2017 GOLD executive summary 1.
Treatment Options
- Long-acting bronchodilators such as tiotropium (Spiriva) 18mcg once daily or salmeterol (Serevent) 50mcg twice daily are commonly used as first-line treatment for chronic cough in COPD.
- Inhaled corticosteroids like fluticasone (50-500mcg twice daily) may be added for patients with persistent cough despite bronchodilator therapy.
- Combination inhalers containing both a long-acting beta-agonist and corticosteroid, such as fluticasone/salmeterol (Advair) 250/50mcg twice daily or budesonide/formoterol (Symbicort) 160/4.5mcg twice daily, are often effective.
- Roflumilast (Daliresp) 500mcg once daily may help reduce cough by decreasing airway inflammation in patients with chronic bronchitis, severe to very severe COPD, and a history of exacerbations 1.
- Mucolytics like N-acetylcysteine (600mg daily) can help thin mucus and improve cough clearance in patients not receiving ICSs 1.
Key Considerations
- Treatment should be individualized based on symptom severity, exacerbation history, and tolerability of side effects.
- The combination of LABA and LAMA has been shown to improve lung function, symptoms, and health status, and reduce exacerbation rates compared to monotherapy 1.
- The addition of an ICS to LABA and LAMA may provide further benefits in reducing exacerbations, but the evidence is not consistent and more research is needed 1.
From the FDA Drug Label
STIOLTO RESPIMAT combines an anticholinergic, tiotropium bromide and a long-acting beta2-adrenergic agonist (LABA) medicine, olodaterol Anticholinergic and LABA medicines such as STIOLTO RESPIMAT help the muscles around the airways in your lungs stay relaxed to prevent symptoms, such as wheezing, cough, chest tightness, and shortness of breath. STIOLTO RESPIMAT is a prescription medicine used to control the symptoms of COPD in adults with COPD.
The medication used to treat chronic cough in Chronic Obstructive Pulmonary Disease (COPD) is tiotropium (INH) as part of the combination medication STIOLTO RESPIMAT which includes tiotropium bromide and olodaterol 2.
- Key points:
- STIOLTO RESPIMAT is used for long-term control of COPD symptoms.
- It helps relax the muscles around the airways to prevent symptoms like cough and shortness of breath.
- Tiotropium is an anticholinergic that helps prevent cough and other COPD symptoms.
From the Research
Medications for Chronic Cough in COPD
- Long-acting muscarinic antagonists (LAMAs) are a recommended first-choice therapeutic option for patients with COPD, including those with chronic cough 3.
- LAMAs such as glycopyrronium, tiotropium, umeclidinium, and aclidinium have been shown to improve lung function, reduce exacerbations, and improve health status in patients with COPD 3, 4, 5.
- Combination therapy with a LAMA and a long-acting β2-agonist (LABA) may be considered for patients with COPD, particularly those with a history of exacerbations or significant symptoms 6, 7.
- The choice of medication should be individualized based on the patient's specific needs and preferences, as well as the delivery device and potential side effects 3.
Specific Medications
- Tiotropium is a well-established LAMA that has been shown to be effective in reducing symptoms and improving lung function in patients with COPD 3, 4.
- Glycopyrronium is another LAMA that has been shown to be effective in improving lung function and reducing exacerbations in patients with COPD 3.
- Aclidinium is a LAMA that has been shown to be effective in improving lung function and reducing symptoms in patients with COPD 3, 5.
- Olodaterol is a LABA that can be used in combination with a LAMA, such as tiotropium, to improve lung function and reduce symptoms in patients with COPD 7.