Chronic Obstructive Pulmonary Disease Treatments

CHRONIC OBSTRUCTIVE PULMONARY DISEASE TREATMENTS
Risk Factors: genetic factors, exposure to particles (tobacco smoke, occupational dusts, outdoor air pollution), oxidative stress, respiratory infections, nutrition, comorbidities.

Classification
• Stage 1: Mild—FEV1/FVC<0.70; FEV1≥80% predicted.
• Stage 2: Moderate—FEV1/FVC<0.70; 50%≤FEV1<80% predicted.
• Stage 3: Severe—FEV1/FVC<0.70; 30%≤FEV1<50% predicted.
• Stage 4: Very Severe—FEV1/FVC<0.70; FEV1<30% predicted or FEV1<50% predicted + CRF.

Step-wise treatment: Visit the Global Initiative for Chronic Obstructive Lung Disease (GOLD) website at www.goldcopd.org for information about use of medications at various stages of COPD.

Generic Brand Form Usual Dosage
BRONCHODILATORS
Long-Acting Beta2‑Agonists (LABAs)
arformoterol Brovana1 soln Adults: Inhale 15mcg twice daily (AM & PM)
by
nebulization (max: 30mcg/day). Use standard
jet
nebulizer with air compressor (see full labeling).

Children: Not recommended.
formoterol Perforomist1,2 soln Adults: One 20mcg vial twice daily (AM & PM)
by
oral inhalation via nebulizer (max: 40mcg/day)

Children: Not recommended.
indacaterol Arcapta Neohaler1,2 caps Adults: 1 inh of one 75mcg caps once daily,
using
Neohaler device. Do not swallow caps.

Children: Not recommended.
olodaterol Striverdi Respimat MDI Adults: 2 inh once daily; max 2 inh/24hrs
Children: Not established.
salmeterol Serevent Diskus2 DPI Adults: 1 inh (50mcg) twice daily (approx. 12hrs apart)

Children: Not established.
Short-Acting Anticholinergics
ipratropium bromide 1 soln Adults: 500mcg by oral nebulization 3−4
times
daily every 6−8hrs

Children: Not recommended.
Atrovent HFA1 MDI Adults: 2 inh 4 times daily (max: inh/day)

Children: Not recommended.
Long-Acting Anticholinergics
aclidinium bromide Tudorza Pressair DPI Adults: 1 inh (400mcg) twice daily 
Children: Not established.
glycopyrrolate Lonhala Magnair soln Adults: 1 oral inh of one 25mcg vial twice daily (AM & PM), using Magnair device

Children: Not established.
Seebri Neohaler caps Adults: 1 oral inh of one 15.6mcg caps twice daily (AM & PM). Do not swallow caps.

Children: Not established.
revefenacin Yupelri1 soln Adults: 1 oral inh of one 175mcg vial once daily using a mouthpiece. Use standard jet nebulizer with air compressor.
Children: Not established.
tiotropium bromide Spiriva HandiHaler1 caps Adults: 2 oral inhalations of one 18mcg caps
once
daily, using HandiHaler device. Do not swallow caps.

Children: Not recommended.
umeclidinium Incruse Ellipta DPI Adults: 1 inhalation every 24hrs 
Children: Not established.
Anticholinergic + Beta2‑Agonist
ipratropium bromide + albuterol 1 soln ≥18yrs: 1 vial (3mL) 4−6 times daily via nebulizer

<18yrs: Not recommended
Combivent 
Respimat
1
MDI Adults: 1 inh 4 times daily (max: 6 inh/day)

Children: Not recommended.
Anticholinergic + Long-Acting Beta2‑Agonist (LABA)
glycopyrrolate + formoterol Bevespi Aerosphere1,2 MDI Adults: 2 inh twice daily (in the AM + PM); max 2 inh twice daily 
Children: Not established.
glycopyrrolate + indacaterol Utibron Neohaler caps Adults: 1 oral inh of one 27.5mcg/15.6mcg caps twice daily (AM & PM), using Neohaler device. Do not swallow caps.

Children: Not established.
tiotropium + olodaterol Stiolto Respimat MDI Adults: 2 inh once daily (max: 2 inh/24hrs)

Children: Not established.
umeclidinium + vilanterol Anoro Ellipta DPI Adults: 1 inh once daily

Children: Not established.
CORTICOSTEROIDS
Corticosteroid + Long-Acting Beta2-Agonist (LABA)
budesonide + formoterol Symbicort 160/4.52 MDI Adults: 2 inh of 160/4.5mcg twice daily

Children: Not indicated.
fluticasone + salmeterol Advair 250/50 Diskus2,3 DPI Adults: 1 inh of 250/50mcg twice daily (approx. 12hrs apart)

Children: Not established.
Wixela Inhub2 DPI Adults: 1 inh of 250/50mcg twice daily (approx. 12hrs apart)
Children: Not established.
fluticasone + vilanterol Breo Ellipta DPI Adults: 1 inh of 100/25mcg once daily (max)

Children: ≤17yrs: Not established.
Corticosteroid + Anticholinergic + Long-Acting Beta2-Agonist (LABA)
fluticasone + umeclidinium + vilanterol Trelegy Ellipta1,2 DPI Adults: 1 inh once daily (max)

Children: Not established.
OTHER
PDE4-Inhibitor
roflumilast Daliresp1,2 tabs Adults: One 500mcg tab once daily 
Children: Not recommended.
NOTES

Key: CRF = chronic respiratory failure; 
DPI = dry powder inhaler;  FEV1 = forced expiratory volume in
one second;  FVC = forced vital capacity;  MDI = metered dose inhaler

1Indicated only for COPD.
2Not indicated for the relief of acute bronchospasm.
3Only Advair 250/50 Diskus twice daily is approved for
maintenance treatment of COPD because an efficacy advantage of the higher strength Advair
500/50 over Advair 250/50 has not been demonstrated. Other strengths and formulations of
Advair are available.

Not an inclusive list of medications and/or official indications.
Please see drug monograph at www.eMPR.com and/or contact
company for full drug labeling.

(Rev. 4/2019)

This article originally appeared on MPR