COPD: The two biggest challenges and changes in treatment
REPORTING FROM THE ANNUAL CARDIOLOGY, ALLERGY, AND RESPIRATORY DISEASE SUMMIT
Treatment changes
The Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2018 report (https://goldcopd.org/wp-content/uploads/2017/11/GOLD-2018-v6.0-FINAL-revised-20-Nov_WMS.pdf) brings with it a new treatment recommendation, Ortiz said. “We used to recommend, and many providers still do, starting with a long-acting beta-agonist bronchodilator (LABA) and then adding an inhaled corticosteroid, much like we do in asthma,” Ortiz explained. But patients who require more than just a LABA should be given a long-acting muscarinic receptor antagonist (LAMA). “That’s the preferred treatment,” Ortiz said. An inhaled corticosteroid would then be added as a 3rd agent, if necessary. “So, the order of therapy is now to start with a bronchodilator (either a LABA or LAMA), then add an agent from whichever of these 2 classes was not already started, and then add a corticosteroid,” Ortiz summarized.
Ortiz said that one of the most significant changes in the treatment of COPD is the recent availability of a therapy that combines an inhaled corticosteroid, a LAMA, and a LABA in one inhaler for once-daily dosing.
