From the Research
The initial treatment for nonemphysematous obstruction due to small-airways disease should involve bronchodilators, particularly short-acting beta-2 agonists (SABAs) like albuterol and anticholinergics such as ipratropium bromide, with the addition of long-acting bronchodilators and inhaled corticosteroids (ICS) as needed based on symptom control and exacerbation frequency. The treatment approach should prioritize the reduction of symptoms and the prevention of exacerbations, with a focus on improving quality of life and reducing morbidity and mortality. Key considerations in the management of nonemphysematous obstruction due to small-airways disease include:
- The use of SABAs like albuterol (2-4 puffs every 4-6 hours as needed) for acute symptom relief 1
- The addition of anticholinergics such as ipratropium bromide (2 puffs four times daily) for patients with persistent symptoms
- The use of long-acting bronchodilators, including long-acting beta agonists (LABAs) like salmeterol or formoterol, and long-acting muscarinic antagonists (LAMAs) like tiotropium, for patients with persistent symptoms despite SABA use 2
- The consideration of ICS, such as fluticasone or budesonide, in combination with bronchodilators for patients with features of asthma or frequent exacerbations 3
- The importance of proper inhaler technique and regular assessment to ensure optimal medication delivery to the small airways
- The need for a stepwise approach to treatment, with escalation of therapy based on symptom control and exacerbation frequency.