From the Guidelines
A COPD patient experiencing an exacerbation who is using Ventolin (salbutamol) and Atrovent (ipratropium) rescue inhalers should continue their scheduled home budesonide-formoterol inhaler. The rescue inhalers provide immediate bronchodilation to address acute symptoms, while budesonide-formoterol offers both anti-inflammatory effects (budesonide) and long-acting bronchodilation (formoterol) [ 1 ]. Maintaining the scheduled inhaler helps control underlying inflammation and provides sustained bronchodilation, which complements the short-acting rescue medications.
According to the Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 report, maintenance therapy with long-acting bronchodilators should be initiated as soon as possible before hospital discharge [ 1 ]. This suggests that continuing the scheduled budesonide-formoterol inhaler is crucial in managing the underlying disease process. Discontinuing the maintenance therapy during an exacerbation could potentially prolong recovery time and worsen outcomes.
The combination of both rescue and maintenance therapies addresses different aspects of COPD exacerbation - immediate symptom relief and underlying disease control. If the patient is having difficulty using multiple inhalers due to breathlessness, prioritize the rescue medications first, followed by the maintenance inhaler when they're able, but aim to maintain the complete regimen if possible. The American College of Chest Physicians and Canadian Thoracic Society guideline also recommends maintenance combination inhaled corticosteroid/long-acting β-agonist therapy to prevent acute exacerbations of COPD [ 1 ].
Key points to consider in the management of COPD exacerbations include:
- An exacerbation of COPD is an acute worsening of respiratory symptoms that results in additional therapy [ 1 ]
- The goal for treatment of exacerbations is to minimize the negative impact of the current exacerbation and to prevent subsequent events [ 1 ]
- Systemic corticosteroids improve lung function and oxygenation and shorten recovery time and hospitalization duration [ 1 ]
- Maintenance therapy with long-acting bronchodilators should be initiated as soon as possible before hospital discharge [ 1 ]
Overall, continuing the scheduled budesonide-formoterol inhaler in a COPD patient experiencing an exacerbation is essential for maintaining control of the underlying disease process and preventing further exacerbations [ 1, 1, 1 ].
From the Research
COPD Exacerbation Treatment
- The treatment of COPD exacerbations typically involves the use of bronchodilators, such as Ventolin and Atrovent, as well as oral corticosteroids and antibiotics if necessary 2.
- Inhaled corticosteroids, such as budesonide, may also be used in the treatment of COPD exacerbations, particularly in patients with a history of frequent exacerbations 3, 4.
Continuing Budesonide-Formoterol During Exacerbation
- A study published in 2009 found that budesonide/formoterol was as effective as prednisolone plus formoterol in the treatment of acute COPD exacerbations in non-hospitalized patients 3.
- Another study published in 2013 found that combination therapy with budesonide/formoterol was more effective than fluticasone/salmeterol in preventing exacerbations in patients with COPD 5.
- A 2021 review of COPD exacerbation fundamentals suggests that inhaled therapy, including dual bronchodilators and triple therapy, is key in the long-term prevention of exacerbations 2.
- It is likely that continuing budesonide-formoterol during an exacerbation would be beneficial, as it may help to reduce the severity and duration of the exacerbation, as well as prevent future exacerbations 3, 5, 2.