From the Guidelines
The treatment of choice for a cold exacerbation in patients with chronic obstructive lung disease (COPD) is short-acting inhaled β2-agonists, with or without short-acting anticholinergics, as the initial bronchodilators, along with systemic corticosteroids to improve lung function and oxygenation. This approach is based on the most recent and highest quality evidence from the Global Initiative for Chronic Obstructive Lung Disease (GOLD) report 1. The goal of treatment is to minimize the negative impact of the current exacerbation and prevent subsequent events.
When managing a cold exacerbation in COPD patients, it is essential to consider the following key points:
- Exacerbations can be precipitated by several factors, with respiratory tract infections being the most common cause 1.
- Systemic corticosteroids have been shown to improve lung function (FEV1) and oxygenation, and shorten recovery time and hospitalization duration 1.
- Antibiotics may be indicated in certain cases, and their use can shorten recovery time and reduce the risk of early relapse, treatment failure, and hospitalization duration 1.
- Non-invasive ventilation (NIV) should be the first mode of ventilation used to treat acute respiratory failure 1.
In terms of specific treatment options, the following may be considered:
- Short-acting inhaled β2-agonists, such as salbutamol or albuterol, can be used as needed to relieve bronchospasm 1.
- Systemic corticosteroids, such as prednisone, can be used to reduce inflammation and improve lung function 1.
- Antibiotics, such as amoxicillin or azithromycin, may be indicated in cases where a bacterial infection is suspected or confirmed 1.
From the FDA Drug Label
Roflumilast tablet is indicated as a treatment to reduce the risk of COPD exacerbations in patients with severe COPD associated with chronic bronchitis and a history of exacerbations. The treatment of choice for cold exacerbation is not directly mentioned in the provided drug labels. However, Roflumilast is indicated for reducing the risk of COPD exacerbations in patients with severe COPD associated with chronic bronchitis and a history of exacerbations 2 2.
- Key points:
- Roflumilast is not a bronchodilator and is not indicated for the relief of acute bronchospasm.
- Roflumilast is indicated for patients with severe COPD associated with chronic bronchitis and a history of exacerbations.
From the Research
Treatment of Choice for Cold Exacerbation
- The treatment of choice for COPD exacerbations includes bronchodilators, corticosteroids, and antibiotics 3.
- Strong evidence exists for the benefit of corticosteroids for exacerbations and of antibiotics in the acute hospital setting 3.
- Targeted O2 therapy improves outcomes and should be titrated to an SpO2 of 88-92% 4.
- Noninvasive ventilation (NIV) is standard therapy for patients who present with COPD exacerbation and is supported by clinical practice guidelines 4.
Medication Regimens
- Combined corticosteroid and long-acting beta(2)-agonist in one inhaler is more effective than inhaled corticosteroids alone for chronic obstructive pulmonary disease 5.
- The combination of ICS and LABA offers some clinical benefits in COPD compared with ICS alone, especially for reduction in exacerbations 5.
- Different ICS/LABA combinations have different efficacy and safety profiles, with budesonide/formoterol and fluticasone/salmeterol being two of the most frequently used combinations 6.
- Budesonide/formoterol may have a greater efficacy than fluticasone/salmeterol in reducing hospital or emergency department admissions, oral corticosteroid courses, and addition of tiotropium 6.
Real-World Effectiveness and Safety
- In a real-world clinical practice setting, budesonide-formoterol was generally as effective as fluticasone-salmeterol at reducing the incidence of moderate-severe exacerbations 7.
- Budesonide-formoterol was more effective than fluticasone-salmeterol at reducing the incidence of severe exacerbation and the risk of severe pneumonia, particularly in patients with higher blood eosinophil counts 7.