What are the available inhaler brands and treatments for Chronic Obstructive Pulmonary Disease (COPD)?

Available Inhaler Brands and Treatments for COPD

The most effective inhaler treatments for COPD are long-acting muscarinic antagonists (LAMAs) as first-line therapy for symptomatic patients, with combination therapies recommended for more severe disease or inadequate response to monotherapy. 1

Classes of COPD Inhalers

Short-Acting Bronchodilators

• Short-acting β2-agonists (SABAs) such as salbutamol (albuterol) or terbutaline are recommended for mild COPD or as rescue medication 2, 3
• Short-acting muscarinic antagonists (SAMAs) such as ipratropium bromide are alternatives for mild disease 2
• Available in metered-dose inhalers (MDIs), which are the most cost-effective delivery devices 3

Long-Acting Bronchodilators (Monotherapy)

• Long-acting muscarinic antagonists (LAMAs) are recommended as first-line therapy for symptomatic COPD patients with FEV1 <60% predicted 1
• LAMAs have demonstrated greater effect on exacerbation reduction compared to LABAs 1, 4
• Long-acting β2-agonists (LABAs) are alternative monotherapy options 2
• Common LAMA brands include tiotropium (Spiriva) 1, 5
• Common LABA brands include olodaterol (Striverdi Respimat) 6 and vilanterol (in combination products) 7

Combination Therapies

• LABA/LAMA combinations are the highest-ranked treatment to reduce COPD exacerbations 4
• LABA/ICS (inhaled corticosteroid) combinations are recommended for patients with frequent exacerbations 2
• Triple therapy (LAMA + LABA + ICS) is recommended for severe COPD (GOLD 4) when previous therapies are insufficient 2

Inhaler Device Types

Metered-Dose Inhalers (MDIs)

• Most convenient, efficient, and cost-effective method for delivering bronchodilator medications 3
• Recommended with spacers as first-line non-powder inhaler option 3
• Proper technique is essential for effective medication delivery 3

Soft Mist Inhalers

• Respimat technology offers an alternative delivery mechanism 8
• Available medications include olodaterol (Striverdi Respimat) 6
• Patients tend to prefer Soft Mist Inhalers over traditional devices 8

Dry Powder Inhalers (DPIs)

• Alternative to MDIs for patients who cannot effectively use MDIs despite proper instruction 3, 9
• Require less coordination between actuation and inhalation 9

Nebulizers

• Recommended for acute exacerbations or patients who cannot effectively use handheld inhalers 3
• Should be driven by air, not oxygen, in patients with carbon dioxide retention 3

Treatment Algorithm Based on Disease Severity

Mild COPD (GOLD 1)

• SABA or SAMA as needed 2
• Avoidance of risk factors and vaccinations 2

Moderate COPD (GOLD 2)

• LAMA (preferred) or LABA monotherapy 2, 1
• Consider rehabilitation programs 2

Severe COPD (GOLD 3)

• LAMA monotherapy or LABA/ICS combination for patients with frequent exacerbations 2
• Consider adding second bronchodilator if symptoms persist 1, 10

Very Severe COPD (GOLD 4)

• Triple therapy (ICS + LABA + LAMA) 2
• Consider long-term oxygen therapy and surgical options 2

Important Considerations and Caveats

• ICS-containing inhalers are associated with an increased risk of pneumonia 4
• Beta-blocking agents should be avoided in COPD patients 1
• Inhaler technique must be demonstrated and checked periodically 1, 3
• If a patient cannot use an MDI correctly, a more expensive device is justified 3
• Individual differences in response exist; consider switching between classes if response is poor 1
• LABA/LAMA combinations appear more effective than monotherapies for improving symptoms and quality of life 4