From the Guidelines
COPD management should prioritize a comprehensive approach focusing on symptom relief, reducing exacerbations, and slowing disease progression, with LABD maintenance therapy recommended in all symptomatic patients with COPD confirmed by spirometry, as per the 2023 Canadian Thoracic Society guideline 1. The management of Chronic Obstructive Pulmonary Disease (COPD) involves a multifaceted approach that includes pharmacological and non-pharmacological interventions.
Key Management Strategies
- Pharmacological Management:
- Long-acting beta-agonists (LABAs) and long-acting muscarinic antagonists (LAMAs) are recommended for moderate to severe disease.
- Combination therapy with LABA/LAMA or adding inhaled corticosteroids (ICS) is recommended for patients with persistent symptoms or frequent exacerbations.
- Non-Pharmacological Interventions:
- Smoking cessation is the most effective intervention to slow COPD progression.
- Pulmonary rehabilitation improves exercise capacity and quality of life.
- Oxygen therapy is indicated for patients with severe hypoxemia.
- Vaccinations against influenza and pneumococcal disease are essential preventive measures.
Treatment Approach
According to the 2023 Canadian Thoracic Society guideline on pharmacotherapy in patients with stable COPD, single inhaler dual therapy LABD is recommended in those with moderate to severe dyspnea and/or poor health status, with a step up to single-inhaler triple therapy in those with persistent moderate to severe dyspnea and/or poor health status despite treatment with single inhaler dual therapy with LAMA/LABA or ICS/LABA 1.
Reducing Mortality and Exacerbations
The guideline also suggests that SITT reduces mortality in individuals with moderate-severe disease and a high risk of AECOPD, and recommends SITT in all patients at high risk of AECOPD 1.
Clinical Considerations
When managing COPD, it is essential to consider the individual patient's symptoms, health status, and risk of exacerbations, and to implement a personalized treatment plan that includes both pharmacological and non-pharmacological interventions, as recommended by the 2023 Canadian Thoracic Society guideline 1.
From the FDA Drug Label
- 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. Wixela Inhub® 250/50 is also indicated to reduce exacerbations of COPD in patients with a history of exacerbations
- 2 Chronic Obstructive Pulmonary Disease The recommended dosage for patients with COPD is 1 inhalation of Wixela Inhub® 250/50 twice daily, approximately 12 hours apart. If shortness of breath occurs in the period between doses, an inhaled, short-acting beta2-agonist should be taken for immediate relief
The management options for Chronic Obstructive Pulmonary Disease (COPD) include:
- Twice-daily maintenance treatment with Wixela Inhub® 250/50 to improve airflow obstruction
- Reduction of exacerbations in patients with a history of exacerbations using Wixela Inhub® 250/50
- Use of an inhaled, short-acting beta2-agonist for immediate relief of shortness of breath between doses 2
From the Research
Management Options for Chronic Obstructive Pulmonary Disease (COPD)
The management of COPD involves the use of various pharmacological and non-pharmacological interventions. The following are some of the management options for COPD:
- Bronchodilators: Long-acting inhaled bronchodilators, such as long-acting β2 agonists (LABAs) or long-acting muscarinic antagonists (LAMAs), are the cornerstone of maintenance therapy for patients with moderate-to-very-severe COPD 3, 4, 5, 6, 7.
- Combination Therapy: For patients not sufficiently controlled on a single long-acting bronchodilator, a combination of different bronchodilators has shown a significant increase in lung function 3, 7.
- Tiotropium: Tiotropium, a once-daily dosing LAMA, has demonstrated sustained improvements in lung function, improved health-related quality of life, reduced exacerbations, and increased survival without altering the rate of decline in the mean forced expiratory volume in 1 second (FEV1) with fairly tolerable side effects 3, 4, 5, 6.
- Olodaterol: Olodaterol is a once-daily dosing LABA that has proven to be effective in improving lung function, reducing rescue medication use, and improving dyspnea and health-related quality of life, as well as improving exercise endurance with an acceptable safety profile 3, 7.
- LAMA/LABA Fixed-Dose Combinations: LAMA/LABA fixed-dose combinations (FDCs) provide the convenience of two bronchodilators with different mechanisms of action in a single inhaler and are likely to become a standard pharmacological strategy for COPD 7.
- Prevention and Management of Exacerbations: Preventing and managing exacerbations are major goals of COPD management, and tiotropium has been shown to reduce the proportion of patients experiencing at least one exacerbation and delay the time to the first exacerbation compared with placebo 6.