From the Guidelines
For a COPD exacerbation, a combination of Breztri (budesonide/glycopyrrolate/formoterol), doxycycline, and Pulmicort (budesonide) nebulizer can be an effective treatment approach. Breztri is a triple therapy inhaler containing an inhaled corticosteroid, long-acting muscarinic antagonist, and long-acting beta-agonist, typically used as a maintenance medication at a dosage of two inhalations twice daily. During an exacerbation, continue using Breztri as prescribed. Add doxycycline 100mg twice daily for 5-7 days to address potential bacterial infection, which commonly triggers COPD flares. Pulmicort nebulizer (0.5-1mg twice daily) provides additional anti-inflammatory effects directly to the airways. This combination works by reducing airway inflammation (budesonide), relaxing airway muscles (formoterol), decreasing mucus production (glycopyrrolate), and treating bacterial infection (doxycycline) 1.
Some key points to consider when managing COPD exacerbations include:
- Ensuring proper hydration to help thin out mucus and make it easier to cough up
- Using a spacer with Breztri if available to improve medication delivery
- Rinsing your mouth after using corticosteroids to prevent thrush
- Contacting your healthcare provider if symptoms worsen or don't improve within 48-72 hours, as systemic steroids or hospitalization may be necessary for severe exacerbations 1.
It's also important to note that the management of COPD exacerbations should be individualized and based on the severity of the exacerbation, as well as the patient's underlying health status and medical history 1. The goal of treatment is to minimize the negative impact of the current exacerbation and to prevent subsequent events, while also improving the patient's quality of life and reducing morbidity and mortality 1.
From the Research
Breztri, Doxy, and Pulmicort Nebulizer for COPD Exacerbation
- The management of COPD exacerbations involves various pharmacologic and non-pharmacologic strategies, including inhaled bronchodilators, systemic steroids, antibiotics, and non-invasive ventilation 2.
- Breztri (budesonide/glycopyrronium/formoterol) is an inhaled fixed-dose combination of an inhaled corticosteroid, a long-acting muscarinic antagonist, and a long-acting β2-agonist, approved for the maintenance treatment of COPD 3.
- Studies have shown that Breztri reduces the rates of moderate/severe COPD exacerbations and improves lung function to a greater extent than budesonide/formoterol and/or glycopyrronium/formoterol 4, 3.
- Doxy (doxycycline) is an antibiotic that may be used to treat COPD exacerbations caused by bacterial infections 5.
- Pulmicort (budesonide) is an inhaled corticosteroid that may be used to treat COPD exacerbations, especially in patients with a history of exacerbations 5.
- The use of a nebulizer to deliver these medications may be beneficial for patients with COPD exacerbations, especially those who have difficulty using inhalers 6.
Treatment Options for COPD Exacerbation
- Inhaled short-acting bronchodilators can be provided by nebulizer (jet or mesh), pressurized metered-dose inhaler (pMDI), pMDI with spacer or valved holding chamber, soft mist inhaler, or dry powder inhaler 6.
- Non-invasive ventilation (NIV) is standard therapy for patients who present with COPD exacerbation and is supported by clinical practice guidelines 6, 5.
- Corticosteroids or antibiotics and measures to support the respiratory system, including NIV, may be used to manage COPD exacerbations 5.
- Targeted therapies directed towards specific pathways of inflammation are being explored in exacerbation prevention, and this is a promising avenue for future research 5.