What are the doses for Dry Powder Inhalers (DPIs) available in the USA for Chronic Obstructive Pulmonary Disease (COPD)?

Dry Powder Inhaler (DPI) Doses for COPD in the USA

The standard doses for dry powder inhalers (DPIs) available in the USA for COPD treatment include vilanterol 25 mcg once daily in combination products and formoterol doses that vary by specific product, with most DPIs requiring only one inhalation per dose for optimal delivery.

Available DPI Medications for COPD

Long-Acting Beta-Agonists (LABAs)

• Vilanterol

  • Dose: 25 mcg once daily (available only in combination products) 1
  • Administration: 1 actuation of BREO ELLIPTA (fluticasone/vilanterol) 100/25 mcg once daily

• Formoterol

  • Available in various DPI formulations
  • Dosing depends on specific product formulation 2
  • Minimal accumulation with multiple dosing (accumulation index 1.19-1.38)

Long-Acting Muscarinic Antagonists (LAMAs)

• Available in various DPI formulations
• Typically administered once daily

Combination Products

• LABA/ICS combinations:

  • Fluticasone/vilanterol (BREO ELLIPTA): 100/25 mcg, one inhalation once daily 1

• LABA/LAMA combinations:

  • Available in various DPI formulations
  • Typically administered once daily

DPI Device Considerations

Patient Technique

• 10-40% of COPD patients make important errors when using dry powder inhalers, depending on the specific device 3
• Inhaler technique must be demonstrated to patients before prescribing and should be re-checked regularly 3

Peak Inspiratory Flow Requirements

• DPIs require sufficient inspiratory flow to overcome internal device resistance
• Patients with severe COPD may have challenges generating adequate inspiratory flow 4

Treatment Algorithm Based on Disease Severity

Mild COPD

• No symptoms: No drug treatment needed 3
• With symptoms: Trial of short-acting bronchodilator via DPI as needed 3

Moderate COPD

• First-line: Long-acting bronchodilator (LAMA or LABA) via DPI once daily 3, 5
• If inadequate control: Consider combination therapy

Severe/Very Severe COPD

• Recommended: LAMA + LABA combination via DPI 5
• For frequent exacerbations: Consider triple therapy (LABA/LAMA/ICS) via DPI, especially with blood eosinophil count ≥300 cells/μL 3, 5

Important Clinical Considerations

Device Selection

• If patient cannot use a metered dose inhaler correctly, a DPI may be more appropriate 3
• For high doses of inhaled corticosteroids (≥1,000 μg/day), a dry powder system is recommended 3

Assessment Before Prescribing

Before prescribing a DPI for home use:

1. Review the diagnosis
2. Ensure optimal use of metered dose inhalers has been attempted
3. Confirm patient can generate adequate inspiratory flow
4. Verify patient responds to the medication 3

Common Pitfalls to Avoid

• Inadequate training: Always demonstrate proper technique and have patient demonstrate back
• Insufficient inspiratory flow: Consider alternative delivery systems for patients with very severe COPD
• Inappropriate device selection: Match the device to the patient's capabilities
• Beta-blockers: Avoid in COPD patients (including eye drop formulations) 3

DPIs offer an effective delivery method for COPD medications when used correctly, but patient technique and appropriate device selection are critical for optimal treatment outcomes.