What are the medication names and dosages for managing Chronic Obstructive Pulmonary Disease (COPD)?

Medication Management for Chronic Obstructive Pulmonary Disease (COPD)

The primary medications for managing COPD include short-acting bronchodilators for symptom relief, long-acting bronchodilators (LAMAs and LABAs) as maintenance therapy, with inhaled corticosteroids added for patients with frequent exacerbations, and systemic corticosteroids and antibiotics for acute exacerbations. 1

Maintenance Therapy for Stable COPD

First-Line Treatment Options

• Short-acting bronchodilators for initial symptom relief:

  • Short-acting β2-agonists (SABAs): Albuterol (90 μg/puff) as needed 1
  • Short-acting muscarinic antagonists (SAMAs): Ipratropium (18 μg/puff) as needed 1

• Long-acting bronchodilators as maintenance therapy:

  • Long-acting muscarinic antagonists (LAMAs): Tiotropium 18 μg once daily 1
  • Long-acting β2-agonists (LABAs): Formoterol, salmeterol twice daily 1

Treatment Based on GOLD Classification

• Group A (Low symptoms, low exacerbation risk):

  • Start with a short-acting bronchodilator (SABA or SAMA) as needed 1
  • If symptoms persist, use a long-acting bronchodilator (LAMA or LABA) 1

• Group B (High symptoms, low exacerbation risk):

  • Initial therapy with a long-acting bronchodilator (LAMA or LABA) 1
  • For persistent breathlessness, use LAMA/LABA combination 1
  • For severe breathlessness, consider initial dual bronchodilator therapy 1

• Group C (Low symptoms, high exacerbation risk):

  • Start with a LAMA (preferred for exacerbation prevention) 1
  • Consider adding a second long-acting bronchodilator or using LABA/ICS if persistent exacerbations 1

• Group D (High symptoms, high exacerbation risk):

  • Initiate LABA/LAMA combination therapy 1
  • Consider LABA/ICS for patients with history of asthma-COPD overlap or high blood eosinophil counts 1
  • For patients with continued exacerbations, consider triple therapy (LABA/LAMA/ICS) 1

Specific Medication Dosages

Short-Acting Bronchodilators

• Albuterol: 90 μg/puff, 1-2 puffs every 4-6 hours as needed 1, 2
• Ipratropium: 18 μg/puff, 2 puffs 4 times daily 1, 2

Long-Acting Bronchodilators

• Tiotropium: 18 μg once daily 3
• Salmeterol: 50 μg twice daily 1
• Formoterol: 12 μg twice daily 4

Combination Therapies

• LABA/LAMA combinations: Used as first-line therapy in Group D patients 5
• LABA/ICS combinations:
  • Fluticasone/Salmeterol: 250-500 μg/50 μg twice daily 2
  • Consider for patients with asthma-COPD overlap or frequent exacerbations 1

Management of Acute Exacerbations

Bronchodilators

• Short-acting β2-agonists with or without short-acting anticholinergics are the initial bronchodilators recommended 1
• No significant differences between metered-dose inhalers (with/without spacer) or nebulizers, though nebulizers may be easier for sicker patients 1

Systemic Corticosteroids

• Prednisone: 40 mg daily for 5 days 1
• Oral administration is equally effective as intravenous 1
• May be less effective in patients with lower blood eosinophil levels 1

Antibiotics

• Indicated for patients with increased sputum purulence or requiring mechanical ventilation 1
• Recommended antibiotics:
  • Amoxicillin, tetracycline derivatives, or amoxicillin/clavulanic acid for 5-7 days 1
  • Alternative options: newer cephalosporins, macrolides, or quinolones 1

Additional Pharmacologic Considerations

• Methylxanthines (e.g., theophylline) are not recommended due to increased side effect profiles 1
• Roflumilast may be considered for patients with FEV1 <50% predicted, chronic bronchitis, and history of hospitalizations 1
• Macrolides can be considered in former smokers with persistent exacerbations despite optimal therapy 1

Common Pitfalls and Caveats

• Avoid methylxanthines due to narrow therapeutic window and significant side effects 1
• ICS use increases risk of pneumonia, especially in Group D patients 1
• Long-term systemic corticosteroids should be avoided due to adverse effects 1
• Consider blood eosinophil levels when deciding on ICS therapy; patients with higher counts may respond better 1, 6
• Ensure proper inhaler technique is taught at first prescription and checked periodically 1