What inhalers can be used to treat chronic bronchitis (Chronic Obstructive Pulmonary Disease, COPD)?

From the Guidelines

For patients with chronic bronchitis, the most effective inhalers are those that combine a long-acting muscarinic antagonist (LAMA) and a long-acting beta-agonist (LABA), with or without an inhaled corticosteroid (ICS), as they improve lung function, symptoms, and health status, and reduce exacerbations 1. When considering treatment options for chronic bronchitis, it's essential to prioritize medications that have been shown to improve morbidity, mortality, and quality of life. The following inhalers can be used:

• Combination inhalers containing both a LAMA and a LABA, such as tiotropium/olodaterol or umeclidinium/vilanterol, which are effective for managing symptoms and reducing exacerbations
• Combination inhalers containing a LAMA, a LABA, and an ICS, such as fluticasone/vilanterol/umeclidinium, which may be beneficial for patients with a history of exacerbations and elevated blood eosinophils
• Anticholinergics like tiotropium (Spiriva) or ipratropium (Atrovent), which help relax airway muscles and are typically used once or twice daily
• Phosphodiesterase-4 inhibitors like roflumilast, which may be added to LAMA/LABA/ICS triple combination therapy for patients with a chronic bronchitic phenotype at high risk of exacerbations Key points to consider when selecting an inhaler include:
• The patient's symptom burden and health status impairment
• The patient's history of exacerbations and risk of future exacerbations
• The presence of elevated blood eosinophils, which may indicate a benefit from ICS therapy
• The potential for adverse effects, such as pneumonia with ICS therapy, or diarrhea and nausea with phosphodiesterase-4 inhibitors 1.

From the FDA Drug Label

Formoterol Fumarate Inhalation Solution is a long-acting beta2-adrenergic agonist (beta2-agonist) indicated for: • Long-term, twice daily (morning and evening) administration in the maintenance treatment of bronchoconstriction in patients with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema. Formoterol Fumarate Inhalation Solution is indicated for the long-term, twice daily (morning and evening) administration in the maintenance treatment of bronchoconstriction in patients with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema.

The inhaler that can be used to treat chronic bronchitis (Chronic Obstructive Pulmonary Disease, COPD) is Formoterol Fumarate Inhalation Solution 2 2.

• Key points:
  • It is a long-acting beta2-adrenergic agonist (beta2-agonist).
  • It is used for maintenance treatment of bronchoconstriction in patients with COPD.
  • It is not indicated to treat acute deteriorations of COPD or asthma.

From the Research

Inhalers for Chronic Bronchitis (COPD)

Inhalers can be used to treat chronic bronchitis, also known as Chronic Obstructive Pulmonary Disease (COPD). The following types of inhalers can be used:

• Short-acting beta-2 agonists (e.g. salbutamol, terbutaline) or anticholinergics (e.g. ipratropium) for patients with mild symptoms 3
• Long-acting beta-2 agonists (e.g. formoterol, indacaterol, olodaterol, salmeterol) or long-acting anticholinergics (e.g. aclidinium, glycopyrronium, tiotropium, umeclidinium) for patients with moderate to severe symptoms 3, 4, 5
• Combination inhalers, such as a long-acting beta-2 agonist and an inhaled corticosteroid (e.g. budesonide-formoterol, beclomethasone dipropionate-formoterol, fluticasone propionate-salmeterol, fluticasone furoate-vilanterol) or a long-acting anticholinergic and a long-acting beta-2 agonist (e.g. glycopyrronium-indacaterol, umeclidinium-vilanterol) for patients with severe symptoms or frequent exacerbations 3, 4, 6, 7
• Triple combination inhalers, which include an inhaled corticosteroid, a long-acting beta-2 agonist, and a long-acting anticholinergic, may be used for patients with very severe COPD and frequent exacerbations 3

Specific Inhalers

Some specific inhalers that can be used to treat COPD include:

• Salmeterol and formoterol, which are long-acting beta-2 agonists that have been shown to improve lung function and reduce symptoms 4, 5
• Tiotropium, which is a long-acting anticholinergic that has been shown to improve lung function and reduce exacerbations 4, 6
• Indacaterol, which is a long-acting beta-2 agonist that has been shown to improve lung function and reduce symptoms 5, 7
• Aclidinium and glycopyrronium, which are long-acting anticholinergics that have been shown to improve lung function and reduce symptoms 4, 7

Combination Therapy

Combination therapy, which involves using multiple inhalers together, may be used to treat COPD. For example:

• A long-acting beta-2 agonist and an inhaled corticosteroid may be used together to improve lung function and reduce inflammation 3, 4, 6, 7
• A long-acting anticholinergic and a long-acting beta-2 agonist may be used together to improve lung function and reduce symptoms 3, 4, 6