How to manage chronic lung disease (CLD) in the Intensive Care Unit (ICU)?

Management of Chronic Lung Disease in the ICU

For patients with chronic lung disease (CLD) in the ICU setting, combination therapy with tiotropium and olodaterol (STIOLTO RESPIMAT) is recommended as it demonstrates superior bronchodilation compared to either agent alone, improving lung function and quality of life. 1

Pharmacological Management

Bronchodilator Therapy

• STIOLTO RESPIMAT (tiotropium/olodaterol combination) provides significantly greater improvement in FEV1 compared to tiotropium or olodaterol monotherapy, with improvements seen as quickly as 5 minutes after the first dose 1
• The combination therapy maintains increased bronchodilator effects throughout the 52-week treatment period, providing sustained relief 1
• Patients treated with the combination therapy use less rescue medication compared to those on monotherapy, indicating better symptom control 1

Clinical Benefits

• STIOLTO RESPIMAT demonstrates superior FEV1 response over the full 24-hour dosing interval compared to monotherapy options 1
• Higher responder rates on the St. George's Respiratory Questionnaire (SGRQ) with combination therapy (53%) versus tiotropium alone (42%) or placebo (31%), indicating improved quality of life 1
• The odds ratio for improvement with combination therapy versus tiotropium was 1.6 (95% CI 1.1,2.4), showing meaningful clinical benefit 1

Exacerbation Management in ICU

• Tiotropium 5 mcg has been shown to reduce the number of COPD exacerbations with a rate ratio of 0.78 (95% CI 0.67,0.92) compared to placebo 1
• Tiotropium also delays time to first COPD exacerbation with a hazard ratio of 0.69 (95% CI 0.63,0.77) 1
• For acute exacerbations in the ICU, antibiotics and/or systemic steroids may be required based on the definition of exacerbations used in clinical trials 1

Practical Administration in ICU Setting

• STIOLTO RESPIMAT is administered once daily in the morning for optimal effect 1
• The inhaler delivers 60 metered actuations and should be discarded 3 months after first use or when the locking mechanism engages 1
• For ICU patients who cannot self-administer, institutional packs with 10 metered actuations are available 1
• Store medication at 20°C to 25°C (68°F to 77°F) in the ICU medication area, avoiding freezing 1

Important Considerations and Cautions

• The combination therapy is not indicated for the treatment of asthma and may increase risk of asthma-related events when used as monotherapy without an inhaled corticosteroid 1
• Concomitant therapy with inhaled steroids (used in 47% of trial participants) and xanthines (used in 10%) is permissible 1
• For patients with severe impairment (GOLD Stage 4,11% of trial participants), the combination therapy still demonstrated benefit 1
• Monitor for response within the first 5 minutes after administration, as measurable improvement should be evident 1