From the Guidelines
For mild COPD with chronic cough, a long-acting muscarinic antagonist (LAMA) such as tiotropium (Spiriva) at 18 mcg once daily or umeclidinium (Incruse Ellipta) at 62.5 mcg once daily is recommended as daily maintenance therapy. According to the most recent guideline from 2023 1, long-acting inhaled bronchodilator maintenance therapy is recommended for all symptomatic individuals with COPD, including those with mild symptom burden. This approach promotes an evidence-informed treatment that aligns with symptom burden, risk of future exacerbations, and mortality risk.
The use of LAMAs has been shown to improve lung function, dyspnea, and health status, and reduce exacerbation rates 1. Additionally, combination therapy with both a LAMA and a long-acting beta-agonist (LABA) in a single inhaler, such as umeclidinium/vilanterol (Anoro Ellipta) at 62.5/25 mcg once daily, may be considered for patients with persistent symptoms or frequent exacerbations. However, for patients with mild COPD, a single inhaler with a LAMA is a suitable option. Proper inhaler technique is crucial for medication effectiveness, and patients should receive demonstration and regular technique checks from healthcare providers.
Key points to consider when selecting a daily inhaler for mild COPD with chronic cough include:
- The use of long-acting inhaled bronchodilators as maintenance therapy
- The recommendation for LAMAs as a first-line treatment option
- The potential benefits of combination therapy with a LAMA and LABA for patients with persistent symptoms or frequent exacerbations
- The importance of proper inhaler technique and regular technique checks.
From the FDA Drug Label
The recommended dosage for patients with COPD is 1 inhalation of Wixela Inhub® 250/50 twice daily, approximately 12 hours apart. The daily inhaler for mild COPD with chronic cough is Wixela Inhub 250/50, administered as 1 inhalation twice daily 2.
- Key points:
- The dosage is the same for patients with mild COPD.
- If shortness of breath occurs in the period between doses, an inhaled, short-acting beta2-agonist should be taken for immediate relief.
From the Research
Daily Inhaler for Mild COPD with Chronic Cough
- Tiotropium bromide (Spiriva) is a long-acting anticholinergic bronchodilator that can be used as a daily inhaler for mild COPD with chronic cough 3, 4, 5, 6.
- It has been shown to improve lung function, reduce symptoms, and improve health-related quality of life in patients with COPD 3, 4, 5, 6.
- Tiotropium bromide has a once-daily dosing regimen, which can improve patient compliance 5.
- It has been compared to other treatments such as ipratropium bromide and salmeterol, and has been shown to be at least as effective, if not more effective, in improving lung function and reducing symptoms 3, 4, 5.
- The most common adverse event associated with tiotropium bromide is dry mouth, which is usually mild and reversible 3, 4, 5, 6.
- Combination therapy with tiotropium bromide and other medications such as inhaled corticosteroids and long-acting beta2-agonists may also be effective in reducing exacerbations and improving quality of life in patients with COPD 7.