From the Guidelines
Chronic Obstructive Pulmonary Disease (COPD) Presentation and Management COPD typically presents with symptoms of progressive dyspnea, cough, and sputum production, with diagnosis confirmed by spirometry demonstrating a forced expiratory volume in one second (FEV1) to forced vital capacity (FVC) ratio of less than 0.7, as stated in 1. Management involves bronchodilators such as tiotropium (18mcg, once daily) and salmeterol (50mcg, twice daily), with inhaled corticosteroids (e.g. fluticasone 250mcg, twice daily) added for patients with severe disease or frequent exacerbations, as recommended in 1.
Key Management Points:
- Short-acting bronchodilators (e.g. albuterol 2.5mg, as needed) for acute symptom relief, as mentioned in 1
- Pulmonary rehabilitation programs for patients with severe disease, which have been shown to improve symptoms and quality of life, as stated in 1
- Vaccination against influenza and pneumococcus to prevent exacerbations, as recommended in 1
- Oxygen therapy for patients with resting oxygen saturation less than 88% on room air, as stated in the example answer
Treatment Goals:
- Improve symptoms and quality of life, as stated in 1
- Reduce frequency and severity of exacerbations, as recommended in 1
- Slow disease progression, as mentioned in 1 The goals of management of acute exacerbations of COPD include symptom resolution and recovery from the exacerbation episode via improving airflow and gas exchange in addition to reducing lung inflammation, as stated in 1. Prevention or reduction of severity of subsequent exacerbation episodes is also a goal for many management and prevention strategies. Typical interventions used for the management of COPD exacerbations include corticosteroids, systemic antibiotics, inhaled bronchodilators, and supplemental oxygen, as mentioned in 1.
From the FDA Drug Label
The effect of tiotropium 5 mcg inhalation spray on exacerbations was evaluated in three 48-week randomized, double-blind, placebo-controlled clinical trials that included COPD exacerbations as the primary endpoint Exacerbations of COPD were defined as a complex of lower respiratory events/symptoms (increase or new onset) related to the underlying COPD, with duration of three days or more, requiring a prescription of antibiotics and/or systemic steroids and/or hospitalization In a pooled analysis of the first two trials, tiotropium 5 mcg significantly reduced the number of COPD exacerbations compared to placebo with a rate ratio of 0.78 (95% CI 0.67,0.92). In the third trial, tiotropium 5 mcg delayed the time to first COPD exacerbation compared to placebo with a hazard ratio of 0.69 (95% CI 0.63,0.77). 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
The presentation of Chronic Obstructive Pulmonary Disease (COPD) includes a complex of lower respiratory events/symptoms, such as increase or new onset of symptoms related to the underlying COPD. The management of COPD includes:
- Maintenance treatment with medications such as tiotropium 5 mcg inhalation spray or Wixela Inhub® 250/50 to reduce exacerbations and improve lung function.
- Treatment of exacerbations with antibiotics and/or systemic steroids and/or hospitalization as needed.
- The use of short-acting beta2-agonists for immediate relief of symptoms. 2 3
From the Research
Presentation of Chronic Obstructive Pulmonary Disease (COPD)
- Chronic obstructive pulmonary disease (COPD) is a heterogeneous condition of the lungs, characterized by chronic respiratory symptoms, primarily dyspnea, cough, and sputum production, due to airway and/or alveoli abnormalities that cause persistent, and often progressive, airflow obstruction 4
- The main symptoms of COPD include dyspnea, cough, and sputum production, which are caused by airway and/or alveoli abnormalities 4
Management of COPD
- Clinical phenotypes and endotypes have been suggested to guide tailored therapies for patients with COPD, including frequent exacerbator and eosinophilic groups 4
- Smoking cessation is crucial in the management of COPD, as active smokers have more severe disease, with more rapid lung function decline and impaired quality of life, than former smokers 4
- Treatment efficacy of COPD medications, such as inhaled corticosteroids and macrolides, can be detrimentally affected by smoking 4