How can the therapy of a 58-year-old male with Chronic Obstructive Pulmonary Disease (COPD) using a combination (combo) medication and inhaler once daily be optimized?

From the Guidelines

To optimize therapy for a 58-year-old male with COPD currently using a combination inhaler once daily, I recommend stepping up to a triple therapy approach using an inhaled corticosteroid/long-acting beta-agonist/long-acting muscarinic antagonist (ICS/LABA/LAMA) combination. This approach is based on the most recent and highest quality evidence, which suggests that triple therapy can reduce exacerbations and improve lung function and quality of life compared to dual therapies in patients with moderate to severe COPD 1. Specifically, consider a once-daily triple therapy such as fluticasone furoate/umeclidinium/vilanterol (Trelegy Ellipta 100/62.5/25 mcg) or beclomethasone/formoterol/glycopyrronium (Trimbow 87/5/9 mcg twice daily). Before making this change, assess his symptom control, exacerbation history, and lung function to confirm inadequate control on current therapy. Ensure proper inhaler technique by demonstrating and having the patient demonstrate back to you. Consider pulmonary rehabilitation if he has persistent symptoms or exercise limitations. Regular follow-up every 3-6 months is essential to monitor response to the new regimen and adjust as needed. Key considerations in managing COPD include smoking cessation, pharmacotherapy, and individualized treatment regimens guided by symptom severity, risk of exacerbations, and patient preferences 1. Inhaler technique needs to be assessed regularly, and influenza and pneumococcal vaccinations can decrease the incidence of lower respiratory tract infections. Pulmonary rehabilitation can improve symptoms, quality of life, and physical and emotional participation in everyday activities. By prioritizing morbidity, mortality, and quality of life, this optimization approach aims to improve overall outcomes for the patient. Some key points to consider in COPD management include:

• Smoking cessation is key
• Pharmacotherapy and nicotine replacement increase long-term smoking abstinence rates
• Inhaler technique needs to be assessed regularly
• Influenza and pneumococcal vaccinations decrease the incidence of lower respiratory tract infections
• Pulmonary rehabilitation improves symptoms, quality of life, and physical and emotional participation in everyday activities. This approach is supported by the American College of Chest Physicians and Canadian Thoracic Society guideline, which recommends maintenance combination inhaled corticosteroid/long-acting beta-agonist therapy for patients with stable moderate, severe, and very severe COPD 1.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION • For oral inhalation only. (2.3) • Maintenance treatment of COPD: 1 actuation of BREO ELLIPTA 100/25 mcg once daily administered by oral inhalation. (2.1)

The patient is already using the inhaler once daily, which is in line with the recommended dosage for COPD treatment. To optimize his therapy, ensure that he is using the inhaler correctly and consistently, and consider monitoring his symptoms and lung function to assess the effectiveness of the current treatment regimen 2.

• Verify that the patient is using the correct dose (1 actuation of 100/25 mcg) and frequency (once daily).
• Assess the patient's adherence to the treatment plan and provide guidance on proper inhaler technique if necessary.

From the Research

Optimizing Therapy for a 58-year-old Male COPD Patient

To optimize therapy for a 58-year-old male COPD patient using a combination inhaler once daily, several factors should be considered:

• The patient's current treatment regimen and its effectiveness in managing symptoms
• The potential benefits of adjusting the dosage or frequency of the current inhaler
• The possibility of adding or switching to a different medication to better control symptoms

Current Treatment Regimen

The patient is currently using a combination inhaler once daily, which may be sufficient for managing mild to moderate COPD symptoms 3. However, for patients with more severe symptoms or those who are not achieving adequate control with once-daily dosing, twice-daily dosing may be necessary 3.

Adjusting Dosage or Frequency

Adjusting the dosage or frequency of the current inhaler may be beneficial for optimizing therapy. For example, the study by 4 compared the early effects of budesonide/formoterol maintenance and reliever therapy with fluticasone furoate/vilanterol for asthma patients requiring step-up from inhaled corticosteroid monotherapy. The results showed that both groups showed improvement in airway inflammation, pulmonary function, and symptoms from baseline to 2 weeks.

Adding or Switching Medications

Adding or switching to a different medication may also be beneficial for optimizing therapy. The study by 5 reviewed the clinical trial data for fluticasone furoate and vilanterol combination inhalers and documented the efficacy and safety of once-daily inhaled maintenance therapy in asthmatic patients. The study by 6 evaluated fluticasone furoate + vilanterol for the treatment of chronic obstructive pulmonary disease (COPD) and found that ICS/LABA combinations provide bronchodilation and decrease the frequency of COPD exacerbations.

Patient Perspectives

Patient perspectives should also be considered when optimizing therapy. The study by 7 compared fluticasone-vilanterol to other corticosteroid combination products for the treatment of asthma and found that individuals may have drug- and device-specific preferences that should be incorporated into therapeutic decision making.

Key Considerations

Key considerations for optimizing therapy for this patient include:

• Monitoring the patient's symptoms and adjusting the treatment regimen as needed
• Considering the potential benefits of adding or switching to a different medication
• Taking into account the patient's preferences and device-specific needs
• Evaluating the efficacy and safety of different treatment options, such as once-daily versus twice-daily dosing 4, 3, 5, 7, 6