From the Guidelines
Medications for COPD should include a combination of long-acting muscarinic antagonists (LAMAs) and long-acting beta-agonists (LABAs) as first-line treatment, with the addition of inhaled corticosteroids (ICS) for patients with frequent exacerbations or more severe symptoms, as recommended by the most recent and highest quality study 1.
Overview of COPD Medications
Medications for COPD typically include bronchodilators as first-line treatment, with short-acting bronchodilators like albuterol (ProAir, Ventolin) used as needed for symptom relief, and long-acting bronchodilators for daily maintenance.
- Long-acting beta-agonists (LABAs) such as salmeterol (Serevent) and formoterol (Foradil) help keep airways open for 12-24 hours.
- Long-acting muscarinic antagonists (LAMAs) like tiotropium (Spiriva) and umeclidinium (Incruse Ellipta) work by blocking acetylcholine receptors to prevent airway constriction.
Combination Therapy
For patients with stable moderate to very severe COPD, maintenance combination inhaled corticosteroid/long-acting beta-agonist therapy is recommended compared with inhaled corticosteroid monotherapy to prevent acute exacerbations of COPD 1.
- Combination treatment with LABA and LAMA increases FEV1 and reduces symptoms compared with monotherapy 1.
- Combination treatment with LABA and LAMA reduces exacerbations compared with monotherapy or ICS/LABA 1.
Additional Treatment Options
- Phosphodiesterase-4 inhibitors such as roflumilast (Daliresp) can help reduce exacerbations in severe COPD with chronic bronchitis.
- During acute exacerbations, oral corticosteroids (prednisone 40mg daily for 5 days) and antibiotics may be prescribed.
- Oxygen therapy becomes necessary when blood oxygen levels fall below certain thresholds.
Treatment Approach
Medication choices depend on symptom severity, exacerbation history, and individual response, with treatment typically following a stepwise approach from single agents to combination therapies as the disease progresses.
- The most recent and highest quality study recommends a combination of LAMAs and LABAs as first-line treatment, with the addition of ICS for patients with frequent exacerbations or more severe symptoms 1.
From the FDA Drug Label
1.1 Maintenance Treatment of COPD tiotropium (INH) is indicated for the long-term, once-daily, maintenance treatment of bronchospasm associated with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema.
The medication for Chronic Obstructive Pulmonary Disease (COPD) is tiotropium (INH), which is used for the long-term, once-daily, maintenance treatment of bronchospasm associated with COPD, including chronic bronchitis and emphysema 2.
- Key points:
- Indication: Maintenance treatment of COPD
- Drug Name: tiotropium (INH)
- Administration: Once-daily, long-term use
From the Research
Medications for Chronic Obstructive Pulmonary Disease (COPD)
The primary medications for COPD include:
- Long-acting β2-agonists (LABAs)
- Long-acting muscarinic antagonists (LAMAs)
- Inhaled corticosteroids (ICS)
- Combination therapies, such as LABA/LAMA and LABA/ICS fixed-dose combinations 3, 4, 5, 6, 7
Types of Medications
Some specific medications for COPD are:
- LABAs: salmeterol, formoterol, indacaterol, olodaterol, vilanterol, milveterol, carmoterol, and abediterol 6, 7
- LAMAs: tiotropium bromide, glycopyrronium bromide, umeclidinium bromide, and aclidinium bromide 6
- LABA/LAMA fixed-dose combinations: indacaterol/glycopyrronium, umeclidinium/vilanterol, and olodaterol/tiotropium 3, 4, 6
- LABA/ICS fixed-dose combinations: fluticasone/salmeterol, budesonide/formoterol, and beclomethasone/formoterol 7
Treatment Recommendations
The Global Initiative for Chronic Obstructive Lung Disease strategy recommends the use of a combination of LABA/LAMA as the first-line treatment option in the majority of symptomatic patients with COPD 4, 5 The American Thoracic Society treatment guidelines strongly recommend LABA/LAMA combination therapy over LAMA or LABA monotherapy in patients with COPD and dyspnea or exercise intolerance 5