What are the treatment options for Chronic Obstructive Pulmonary Disease (COPD)?

From the Guidelines

Treatment of Chronic Obstructive Pulmonary Disease (COPD) typically involves a combination of pharmacological and non-pharmacological interventions. For patients with mild to moderate COPD, treatment with a long-acting muscarinic antagonist (LAMA) such as tiotropium (18mcg, 1 inhalation daily) or a long-acting beta-agonist (LABA) such as salmeterol (50mcg, 1 inhalation twice daily) is recommended 1. For patients with more severe disease, combination therapy with a LAMA and a LABA, such as tiotropium and formoterol (5mcg, 1 inhalation twice daily), or the addition of an inhaled corticosteroid (ICS) such as fluticasone (250mcg, 1 inhalation twice daily) may be necessary 1. Some key points to consider in the treatment of COPD include:

• LAMA/LABA dual therapy is recommended as initial maintenance therapy for individuals with moderate to high symptoms and impaired lung function 1
• Triple therapy with a LAMA, LABA, and ICS may be considered for patients with severe COPD and a history of exacerbations 1
• Phosphodiesterase-4 inhibitors such as roflumilast may be used to reduce exacerbations in patients with severe COPD and a history of exacerbations 1
• Antibiotics such as azithromycin may be used to reduce exacerbations in patients with frequent exacerbations 1
• Mucolytic agents such as N-acetylcysteine may be used to reduce exacerbations in patients with COPD 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. Wixela Inhub® 250/50 is also indicated to reduce exacerbations of COPD in patients with a history of exacerbations

2. 1 Maintenance Treatment of COPD STIOLTO RESPIMAT is a combination of tiotropium bromide and olodaterol indicated for long-term, once-daily maintenance treatment of patients with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and/or emphysema

The treatment options for Chronic Obstructive Pulmonary Disease (COPD) include:

• Wixela Inhub® 250/50: a twice-daily maintenance treatment for airflow obstruction in patients with COPD, including chronic bronchitis and/or emphysema, and to reduce exacerbations of COPD in patients with a history of exacerbations 2
• STIOLTO RESPIMAT: a once-daily maintenance treatment for patients with COPD, including chronic bronchitis and/or emphysema 3

From the Research

Treatment Options for Chronic Obstructive Pulmonary Disease (COPD)

• The treatment of COPD often involves a combination of inhaled corticosteroids, long-acting beta-agonists, and long-acting anticholinergic bronchodilators 4.
• Triple therapy, which includes an inhaled corticosteroid (ICS), a long-acting beta-agonist (LABA), and a long-acting muscarinic antagonist (LAMA), may be beneficial for patients with severe to very severe COPD, particularly those with peripheral blood or sputum eosinophilia, asthma-COPD overlap syndrome, or frequent exacerbators 5.
• The addition of fluticasone-salmeterol to tiotropium therapy may improve lung function, quality of life, and hospitalization rates in patients with moderate to severe COPD 4.
• Triple therapy may reduce rates of moderate-to-severe COPD exacerbations and improve health-related quality of life compared to combination LABA/LAMA inhalers, but may also increase the risk of pneumonia as a serious adverse event 6.
• The LABA/LAMA combination may be the most effective treatment group for reducing COPD exacerbations, followed by LAMA, and may have an advantage over those without a LAMA for preventing COPD exacerbations 7.
• Treatment with ICS in combination with LABA or LABA/LAMA may reduce the risk of exacerbations in COPD, particularly in patients with increased blood eosinophils levels, and may have a small but significant positive effect on lung function decline and decrease mortality 8.

Medication Options

• Tiotropium, salmeterol, and fluticasone-salmeterol are commonly used medications for the treatment of COPD 4.
• LABA/LAMA combinations, such as fluticasone furoate/vilanterol/umeclidinium, budesonide/formoterol/glycopyrronium, and beclometasone/formoterol/glycopyrronium, are available for the treatment of COPD 5.
• Budesonide/formoterol may have a better effect-safety profile compared to fluticasone propionate/salmeterol, with a lower risk of pneumonia 8.

Patient Selection

• Patients with moderate to severe COPD, particularly those with peripheral blood or sputum eosinophilia, asthma-COPD overlap syndrome, or frequent exacerbators, may benefit from triple therapy 5.
• Patients with increased blood eosinophils levels may be more likely to benefit from treatment with ICS 8.