Are inhalers indicated for chronic bronchitis?

From the Guidelines

Yes, inhalers are indicated for chronic bronchitis, particularly for patients with chronic obstructive pulmonary disease (COPD) where chronic bronchitis is a component. The primary inhaler treatments include bronchodilators such as short-acting beta-agonists (SABAs) like albuterol (2 puffs every 4-6 hours as needed) and long-acting bronchodilators including long-acting beta-agonists (LABAs) like formoterol or salmeterol, and long-acting muscarinic antagonists (LAMAs) like tiotropium (18 mcg once daily) 1. For patients with frequent exacerbations, inhaled corticosteroids (ICS) may be added, often in combination inhalers like fluticasone/salmeterol or budesonide/formoterol.

Key Considerations

• Treatment typically follows a stepwise approach, starting with a bronchodilator and adding medications based on symptom severity and exacerbation frequency 1.
• These medications work by relaxing airway smooth muscles to improve airflow and reduce inflammation in the airways, addressing the airflow limitation and mucus hypersecretion characteristic of chronic bronchitis.
• Proper inhaler technique is essential for effective medication delivery, and patients should be instructed on correct usage and maintenance of their specific devices.
• In patients with chronic bronchitis, severe to very severe COPD, and a history of exacerbations, a PDE4 inhibitor like roflumilast may improve lung function and reduce moderate and severe exacerbations 1.
• Regular treatment with mucolytics, such as carbocysteine and N-acetylcysteine, may reduce exacerbations and modestly improve health status in patients not receiving ICSs 1.

Recommendations

• Inhalers should be used as first-line treatment for chronic bronchitis, with the choice of inhaler depending on the severity of symptoms and the presence of exacerbations 1.
• Patients with chronic bronchitis should be assessed for their risk of exacerbations and treated accordingly, with the goal of reducing exacerbation frequency and improving quality of life 1.
• Patients should be educated on proper inhaler technique and adherence to their treatment regimen to ensure optimal outcomes 1.

From the FDA Drug Label

Formoterol Fumarate Inhalation Solution is a long-acting beta2-adrenergic agonist (beta2-agonist) indicated for: • Long-term, twice daily (morning and evening) administration in the maintenance treatment of bronchoconstriction in patients with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema. Formoterol Fumarate Inhalation Solution is indicated for the long-term, twice daily (morning and evening) administration in the maintenance treatment of bronchoconstriction in patients with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema.

Inhalers, such as formoterol, are indicated for chronic bronchitis as part of the maintenance treatment of bronchoconstriction in patients with chronic obstructive pulmonary disease (COPD) 2, 2.

• The recommended dose is one 20 mcg unit-dose vial administered twice daily (morning and evening) by nebulization.
• Key points to consider when using formoterol for chronic bronchitis include:
  • Not indicated to treat acute deteriorations of chronic obstructive pulmonary disease
  • Not indicated to treat asthma
  • Use with caution in patients with cardiovascular or convulsive disorders, thyrotoxicosis, or with sensitivity to sympathomimetic drugs.

From the Research

Inhalers for Chronic Bronchitis

• Inhalers are commonly used to manage symptoms of chronic obstructive pulmonary disease (COPD), which includes chronic bronchitis 3, 4, 5.
• The use of inhaled corticosteroids (ICS) with combination inhaled long-acting beta2-agonists (LABA) and long-acting muscarinic antagonists (LAMA) may reduce rates of moderate-to-severe COPD exacerbations and improve health-related quality of life 3.
• Studies have compared the efficacy of different ICS/LABA combinations, such as budesonide/formoterol and fluticasone/salmeterol, in preventing exacerbations in COPD patients 5.
• The PATHOS study found that budesonide/formoterol was more effective than fluticasone/salmeterol in preventing exacerbations in primary care patients with COPD 5.
• However, the benefits and risks of adding ICS to combination LABA/LAMA inhalers as a triple therapy remain unclear, and the certainty of evidence is often downgraded due to inconsistency or indirectness 3.

Types of Inhalers

• Combination inhalers, such as fluticasone propionate/salmeterol, are available for the treatment of COPD 4.
• These inhalers typically contain a combination of a bronchodilator and an inhaled corticosteroid, which can help to improve lung function and reduce symptoms 4.
• The choice of inhaler and medication regimen should be individualized based on the patient's specific needs and medical history 3, 4, 5.

Safety and Efficacy

• The safety and efficacy of inhalers for chronic bronchitis have been evaluated in several studies, including those comparing formoterol and budesonide to salmeterol and fluticasone 6, 7.
• These studies have generally found that the combination of an ICS and a LABA is effective in reducing symptoms and improving lung function, but the risk of serious adverse events, such as pneumonia, should be carefully considered 3, 6, 7.