Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide. It is a chronic disease that affects quality of life and mobility, and can lead to respiratory compromise and exacerbations that require hospitalization. While prevention is key, inhalers are the mainstay of therapy once disease is established.
The Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease (GOLD) Report provides recommendations for COPD management. Its ABCD algorithm for prescribing inhaler therapy — driven by patient symptoms and exacerbation history — is well known and widely used. If symptoms such as dyspnea continue to occur despite initial inhaler therapy, step-up is recommended. The same is true for exacerbations.
The American Thoracic Society (ATS) just released its clinical practice guideline on pharmacologic management of COPD online in the form of a physician summary. The recommendations on using inhalers for dyspnea and respiratory-related quality of life come from a systematic review and meta-analysisalso published online. They examined whether switching from long-acting bronchodilator monotherapy (either long-acting beta-agonist [LABA] or long-acting muscarinic antagonist [LAMA]) to dual (inhaled corticosteroid [ICS]/LABA or LABA/LAMA) or triple (LABA/LAMA/ICS) therapy would improve dyspnea or respiratory-related quality of life. Turns out, there's no significant benefit beyond initial monotherapy.
