What are the treatment options for Chronic Obstructive Pulmonary Disease (COPD) in an outpatient setting?

From the Guidelines

Outpatient treatment for COPD should prioritize long-acting bronchodilator (LABD) maintenance therapy, with single inhaler dual therapy LABD recommended for patients with moderate to severe dyspnea and/or poor health status, and a step up to single-inhaler triple therapy for those with persistent symptoms despite dual therapy, as per the 2023 Canadian Thoracic Society guideline 1. The goal of COPD management is to reduce symptoms, improve quality of life, and prevent exacerbations.

• Maintenance therapy with LABDs, such as long-acting beta-agonists (LABAs) and long-acting muscarinic antagonists (LAMAs), is preferred for symptomatic patients with COPD confirmed by spirometry.
• Single inhaler dual therapy LABD is recommended for patients with moderate to severe dyspnea and/or poor health status.
• For patients with persistent moderate to severe dyspnea and/or poor health status despite treatment with single inhaler dual therapy, a step up to single-inhaler triple therapy, including an inhaled corticosteroid (ICS), is suggested.
• Additionally, smoking cessation, pulmonary rehabilitation, and oxygen therapy for patients with resting oxygen saturation ≤88% or PaO2 ≤55 mmHg are crucial components of COPD management, as supported by previous studies 1. Key considerations in COPD management include:
• Reducing airway inflammation and relaxing bronchial smooth muscle to improve airflow.
• Enhancing patients' functional capacity and slowing disease progression.
• Preventing respiratory infections through vaccinations against influenza, pneumococcal disease, and COVID-19. The most recent and highest quality study, the 2023 Canadian Thoracic Society guideline 1, provides the foundation for these recommendations, prioritizing morbidity, mortality, and quality of life as the primary outcomes.

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

• Treatment options for Chronic Obstructive Pulmonary Disease (COPD) in an outpatient setting include:
  • Wixela Inhub 250/50, a twice-daily maintenance treatment of airflow obstruction
  • STIOLTO RESPIMAT, a once-daily maintenance treatment
• The choice of treatment should be based on the patient's disease severity and medical history 2, 3

From the Research

Treatment Options for COPD in an Outpatient Setting

The treatment options for Chronic Obstructive Pulmonary Disease (COPD) in an outpatient setting include:

• Bronchodilators, which are the mainstay of COPD therapy 4
• Inhaled short-acting beta2-agonists for relief of acute bronchospasm 4
• Inhaled long-acting beta2-agonists for maintenance therapy in patients with persistent symptoms 4, 5
• Long-acting anticholinergic agents for prolonged improvement in lung function 4, 6
• Inhaled corticosteroids to reduce the frequency of acute exacerbations in patients with severe COPD and frequent exacerbations 4, 7
• Combination therapy with different classes of bronchodilators or a bronchodilator with a corticosteroid for greater improvements in lung function and symptoms 4, 8

Nonpharmacologic Interventions

Nonpharmacologic interventions that can benefit patients with COPD include:

• Pulmonary rehabilitation 4
• Oxygen therapy 4
• Surgery 4

Combination Therapies

Combination therapies, such as long-acting β₂-agonist/long-acting muscarinic antagonists (LABA/LAMA) fixed-dose combinations, can provide greater benefits than individual agents alone 8, 6 LABA/LAMA fixed-dose combinations can improve lung function, reduce symptoms and exacerbations, and enhance health-related quality of life 8, 6