Applied Evidence

COPD inhaler therapy: A path to success

Author and Disclosure Information

 

References

Unclear what predominates? Follow the exacerbation predominance pathway.1

Additional decision-making might be necessary in several circumstances:

  • For the patient who requires further titration beyond these pathways, consider triple therapy as LABA + LAMA + ICS, unless the eosinophil count is < 100 cell/μL.1
  • Consider de-escalating ICS therapy if the patient develops pneumonia, there is a lack of demonstrated benefit, or the initial indication was uncertain or inappropriate.
  • For the patient who continues to have significant dyspnea despite dual or triple therapy, consider investigating and treating other causes of dyspnea.1

Last, keep in mind that evidence is limited regarding escalating the dosage of these agents (1) beyond what is listed in TABLE 21 and (2) in specific instances mentioned in the discussion of each inhaler class.

a www.copdfoundation.org/Learn-More/EducationalMaterials-Resources/Educational-Video-Series.aspx

b www.thoracic.org/members/assemblies/assemblies/srn/questionaires/sgrq.php

c Not an FDA-approved combination inhaled-agent treatment; approved in the European Union, under various brand names, by the European Medicines Agency.

c Not an FDA-approved combination inhaled-agent treatment; approved in the European Union, under various brand names, by the European Medicines Agency.

CORRESPONDENCE
Michael Arnold, DO, FAAFP, Carl R. Darnall Army Medical Center, Uniformed Service University, 36065 Santa Fe Avenue, Fort Hood, TX 76544; scalpelandyardstick@gmail.com

Pages

Recommended Reading

Home program improves some functional capacity in COPD
MDedge Family Medicine
Nearly 30% of U.S. cancer deaths linked to smoking
MDedge Family Medicine
Inhaled, systemic steroids linked to changes in brain structure
MDedge Family Medicine
Many young kids with COVID may show no symptoms
MDedge Family Medicine
Cannabis industry cribs Big Tobacco’s social responsibility initiatives
MDedge Family Medicine
RETHINC takes air out of COPD-like therapy for smokers
MDedge Family Medicine
Biomarker-guided steroid therapy shown safe for COPD
MDedge Family Medicine
Unvaccinated 10 times more likely to be hospitalized for Omicron
MDedge Family Medicine
New study supports safety of COVID-19 boosters during pregnancy
MDedge Family Medicine
Influenza vaccine may offer much more than flu prevention
MDedge Family Medicine