What is the treatment for Chronic Obstructive Pulmonary Disease (COPD)?

Treatment of Chronic Obstructive Pulmonary Disease (COPD)

The treatment of COPD should follow a stepwise approach based on symptom burden and exacerbation risk, with bronchodilators as the cornerstone of pharmacological management for all severity levels. 1, 2

Initial Assessment and Classification

• COPD patients should be classified into groups A, B, C, or D based on symptom burden and exacerbation history to guide treatment decisions 2
• Group A: low symptoms, low exacerbation risk
• Group B: high symptoms, low exacerbation risk
• Group C: low symptoms, high exacerbation risk
• Group D: high symptoms, high exacerbation risk 2

Pharmacological Treatment by Disease Severity

Mild COPD (Group A)

• Patients with no symptoms require no drug treatment 1
• For symptomatic patients, use short-acting bronchodilators (beta-agonists or anticholinergics) as needed 1, 3
• Inhaler technique must be demonstrated and regularly checked before prescribing 3, 1

Moderate COPD (Group B)

• Initial therapy should be a long-acting bronchodilator (LABA or LAMA) 1, 2
• Most patients can be controlled on a single long-acting bronchodilator 3, 1
• Long-acting muscarinic antagonists (LAMAs) like tiotropium are preferred for exacerbation prevention compared to LABAs 1, 4

Severe COPD (Groups C and D)

• Combination of LABA and LAMA bronchodilators is recommended for patients with persistent symptoms or exacerbations 1, 5
• LABA/LAMA combinations provide superior outcomes compared to monotherapy in patients with high symptom burden 2, 5
• For patients with history of exacerbations despite LABA/LAMA therapy, adding inhaled corticosteroids (ICS) should be considered 1, 6
• Wixela Inhub® 250/50 (fluticasone/salmeterol) is indicated for twice-daily maintenance treatment of airflow obstruction and to reduce exacerbations in COPD patients with a history of exacerbations 6

Exacerbation Management

• Short-acting bronchodilators are first-line treatment for exacerbations 2
• Systemic corticosteroids (40mg prednisone daily for 5 days) improve recovery time and lung function during exacerbations 1, 2
• Antibiotics can shorten recovery time and reduce risk of early relapse when indicated during exacerbations 1

Non-Pharmacological Management

• Smoking cessation should be continually encouraged for all current smokers 3, 2
• Reduction of exposure to occupational dusts, fumes, gases, and indoor/outdoor air pollutants is essential 3
• Pulmonary rehabilitation is recommended for patients with high symptom burden 2

Special Considerations

• Home nebulizer therapy should only be prescribed after formal assessment by a respiratory physician 3
• Beta-blocking agents (including eyedrop formulations) should be avoided 3, 1
• ICS use increases pneumonia risk, especially in current smokers, older patients, and those with prior pneumonia 2
• For severe disease with emphysema, consider referral for evaluation of lung volume reduction procedures in selected patients 3

Delivery Devices

• Metered dose inhalers are the most cost-effective delivery device, but proper technique is essential 3
• If patients cannot use metered dose inhalers correctly, alternative devices like dry powder inhalers should be considered 3
• Inhaler technique must be demonstrated before prescribing and re-checked regularly 3

Important Pitfalls to Avoid

• Do not use ICS monotherapy in COPD 1
• Do not prescribe home nebulizer therapy without proper assessment 3
• Do not use beta-blockers in COPD patients 3, 1
• Do not use LABA/ICS as first-line therapy unless there are features suggesting asthma-COPD overlap 1
• Do not use higher doses of medications than recommended as this may increase side effects without additional benefit 6