What is the current initial treatment for Chronic Obstructive Pulmonary Disease (COPD)?

From the Guidelines

The initial treatment for COPD typically involves bronchodilators as the cornerstone therapy, with a combination of a long-acting muscarinic antagonist (LAMA) and a long-acting beta-agonist (LABA) often necessary for patients with moderate to very severe symptoms, and inhaled corticosteroids (ICS) added for those with frequent exacerbations and elevated eosinophil counts (≥300 cells/μL). For patients with mild symptoms, a LAMA such as tiotropium (18 mcg once daily) or a LABA like salmeterol (50 mcg twice daily) is recommended 1. As symptoms progress, combination therapy with both LAMA and LABA is often necessary. For patients with frequent exacerbations and elevated eosinophil counts (≥300 cells/μL), ICS like fluticasone (250-500 mcg twice daily) may be added to the bronchodilator regimen 1.

Key Components of Initial Treatment

• Short-acting bronchodilators like albuterol (2-4 puffs every 4-6 hours as needed) for symptom relief
• Long-acting bronchodilators for maintenance therapy
• Combination therapy with LAMA and LABA for patients with moderate to very severe symptoms
• ICS added for patients with frequent exacerbations and elevated eosinophil counts (≥300 cells/μL)
• Pulmonary rehabilitation to improve exercise capacity and quality of life
• Smoking cessation to slow disease progression
• Vaccination against influenza and pneumococcal disease to prevent respiratory infections that can trigger exacerbations

Non-Pharmacological Interventions

• Pulmonary rehabilitation: improves exercise capacity and quality of life
• Smoking cessation: critical to slow disease progression
• Vaccination against influenza and pneumococcal disease: prevents respiratory infections that can trigger exacerbations

Considerations for Treatment

• Triple inhaled therapy of ICS/LAMA/LABA improves lung function, symptoms, and health status and reduces exacerbations compared with ICS/LABA or LAMA monotherapy 1
• Regular treatment with ICSs increases the risk of pneumonia, especially in those with severe disease 1
• Long-term use of oral glucocorticoids has numerous side effects with no evidence of benefits 1

From the FDA Drug Label

1. 2 Maintenance Treatment of Chronic Obstructive Pulmonary Disease Wixela Inhub® 250/50 is indicated for the twice-daily maintenance treatment of airflow obstruction in patients with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and/or emphysema.

The current initial treatment for COPD is Wixela Inhub® 250/50, which is indicated for the twice-daily maintenance treatment of airflow obstruction in patients with COPD.

• The recommended dosage for patients with COPD is 1 inhalation of Wixela Inhub® 250/50 twice daily, approximately 12 hours apart 2.
• Wixela Inhub® 250/50 is also indicated to reduce exacerbations of COPD in patients with a history of exacerbations.

From the Research

Current Initial Treatment for COPD

The current initial treatment for Chronic Obstructive Pulmonary Disease (COPD) involves a combination of pharmacologic and non-pharmacologic approaches.

• The goal of pharmacologic therapy is to reduce symptoms, improve exercise intolerance and health-related quality of life, and to reduce exacerbations 3.
• Inhaled long-acting β2-agonists (LABAs) and long-acting muscarinic antagonists (LAMAs) are equally effective for the symptomatic management of COPD, but LAMAs are more effective than LABAs in the reduction of exacerbations 3.
• The fixed combination of LAMAs and LABAs (dual bronchodilation) is superior to LAMA monotherapy in the prevention of exacerbations 3.
• Adding inhaled corticosteroids (ICS) to LABA and LAMA (triple therapy) for a prevention of exacerbations results in a further reduction of exacerbations, especially in those patients with higher blood eosinophil counts 3.

Non-Pharmacologic Management

Non-pharmacologic management of COPD patients includes:

• Smoking cessation programs 3, 4
• Vaccination, such as pneumococcal and annual influenza vaccinations 4
• Pulmonary rehabilitation 3, 4, 5
• Strategies to improve or maintain physical activity 3
• Good nutrition 4

Pharmacologic Treatment

The main objective of treatment is to relieve daily symptoms, improve quality of life and importantly decrease the risk of future exacerbations 4.

• Bronchodilators are the cornerstone of management, with short-acting bronchodilators used as rescue medication, and long-acting bronchodilators or long-acting muscarinic agents used as the treatment of choice for patients in groups B, C, and D 4.
• Inhaled corticosteroids are only recommended for groups C and D 4.
• Alternative choices for patients who still have frequent exacerbations include long-term macrolides and phosphodiesterase 4 inhibitors 4.