What are the treatment options for Chronic Obstructive Pulmonary Disease (COPD) exacerbation?

From the Guidelines

Treatment for COPD exacerbations should involve a combination of bronchodilators, corticosteroids, and antibiotics when appropriate, with the goal of minimizing morbidity, mortality, and improving quality of life. For acute exacerbations, short-acting bronchodilators like albuterol (2-4 puffs every 4-6 hours) or ipratropium (2-4 puffs every 4-6 hours) via metered-dose inhaler with spacer or nebulizer are first-line treatments to relieve bronchospasm, as recommended by the American Family Physician guideline 1.

Some key points to consider in the management of COPD exacerbations include:

• The use of systemic corticosteroids, such as prednisone (40mg daily for 5 days), to reduce inflammation and speed recovery 1
• The use of antibiotics, such as azithromycin (500mg on day 1, then 250mg daily for 4 days), amoxicillin-clavulanate (875/125mg twice daily for 5-7 days), or doxycycline (100mg twice daily for 5-7 days), when there are signs of bacterial infection (increased sputum purulence, fever) 1
• The importance of supplemental oxygen therapy for patients with hypoxemia, targeting oxygen saturation of 88-92% 1
• The consideration of non-invasive ventilation for patients with respiratory acidosis 1

It is essential to note that the management of COPD exacerbations should be individualized, taking into account the patient's clinical presentation, medical history, and preferences. The goal of treatment is to minimize the negative impact of the exacerbation, prevent subsequent events, and improve the patient's quality of life. As stated in the European Respiratory Journal guideline, the treatment of COPD exacerbations should be based on the best available evidence and should involve a multidisciplinary approach 1.

In terms of specific treatment recommendations, the Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 report provides a comprehensive overview of the key points for the management of exacerbations, including the use of short-acting bronchodilators, systemic corticosteroids, and antibiotics 1.

Overall, the management of COPD exacerbations requires a comprehensive approach that takes into account the patient's individual needs and preferences, with the goal of minimizing morbidity, mortality, and improving quality of life.

From the FDA Drug Label

The 2 exacerbation trials with fluticasone propionate and salmeterol inhalation powder 250 mcg/50 mcg were identical trials designed to evaluate the effect of fluticasone propionate and salmeterol inhalation powder 250 mcg/50 mcg and salmeterol 50 mcg, each given twice daily, on exacerbations of COPD over a 12-month period Wixela Inhub® 250/50 is also indicated to reduce exacerbations of COPD in patients with a history of exacerbations

The treatment options for Chronic Obstructive Pulmonary Disease (COPD) exacerbation include:

• Fluticasone propionate and salmeterol inhalation powder 250 mcg/50 mcg twice daily, which has been shown to reduce the annual rate of moderate/severe COPD exacerbations compared with salmeterol 50 mcg.
• Wixela Inhub® 250/50, which is indicated to reduce exacerbations of COPD in patients with a history of exacerbations. Key points to consider:
• Dosing: 1 inhalation of Wixela Inhub® 250/50 twice daily, approximately 12 hours apart.
• Short-acting beta2-agonist: should be taken for immediate relief if shortness of breath occurs in the period between doses. 2 2

From the Research

Treatment Options for COPD Exacerbation

The treatment options for Chronic Obstructive Pulmonary Disease (COPD) exacerbation include:

• Systemic corticosteroid therapy, which can be given for a short duration (5-7 days) or a longer duration (10-14 days) 3, 4, 5
• Bronchodilators, such as long-acting muscarinic antagonists (LAMAs) and long-acting β2-agonists (LABAs), which can be used to maximize bronchodilation and reduce exacerbation risk 6
• Inhaled corticosteroids (ICS), which may be added to a LABA/LAMA combination in exacerbating patients with an asthma-COPD overlap syndrome or high blood eosinophil counts 6
• Phosphodiesterase (PDE)-4 inhibitors, such as roflumilast, which may be used in exacerbators with chronic bronchitis 6
• Macrolide antibiotics, such as azithromycin, which may be used in patients who experience frequent bacterial exacerbations and/or bronchiectasis 6
• Pulmonary rehabilitation, which should be included as part of a comprehensive management plan for patients at risk of exacerbations 6

Duration of Systemic Corticosteroid Therapy

Studies have shown that a short duration (5 days) of systemic corticosteroid therapy is non-inferior to a longer duration (10-14 days) in terms of reducing exacerbation risk and improving clinical outcomes 3, 4, 5

• A study published in 2013 found that 5-day treatment with systemic glucocorticoids was non-inferior to 14-day treatment with regard to re-exacerbation within 6 months of follow-up 5
• Another study published in 2018 found that short-duration (7 or fewer days) systemic corticosteroid treatment was equivalent to longer-duration (longer than 7 days) treatment in terms of risk of treatment failure, relapse, and adverse events 3, 4

Importance of Guideline-Based Therapy

Guideline-based therapy is important in reducing the risk of exacerbations and improving clinical outcomes in patients with COPD 7

• A study published in 2019 found that an interprofessional education seminar and pocket reference sheet realigned clinical practice with guideline-based therapy, resulting in improved patient outcomes and reduced length of stay 7