Antonio Anzueto, MD; James F. Donohue, MD; Peter Salgo, MD; Byron Thomashow, MD; and Barbara P. Yawn, MD, MSc, FAAFP, review the various drug classes used in the treatment of chronic obstructive pulmonary disease (COPD).
Let’s talk a little bit now about what you were talking about some of these treatment decisions what we’ve got out there we’ve got the the short acting the long-acting bronchodilators long-acting muscarinic s– inhaled corticosteroids how do you make decisions about these things what are you using whom yeah so the you know this is very very complicated because
We do have a lot of i wouldn’t be asking but a lot of them are meters alright and i think the best place to go and would be the you know the gold guidelines really has made it very nice and simple i think everybody needs a short-acting rescue medicine like albuterol or petropia more the two together that’s a sama as a summer or a asaba or even in combination and
That’s the kind of thing like an asthma you can actually if it’s the only thing you have you could pretreat yourself before you walk and you get something out of it most people start with a long-acting bronchodilator a 12 hour or 24 hour and that could be either a anti muscarinic agent a beta agonist long-acting beta agonist or what i really like to make life
Really simple is both alright as the first first drug now what everyone has used for years are inhaled steroids and long-acting beta agonists because that’s simple that’s an a really good asthma therapy first line there and then all these patients are wheezing don’t do first line they’re either yeah but that revolutionized the lives of our patients with you know
With with with asthma copd ics is first line you’re right barb the but anyway well one size fits well that’s what i was saying it’s a simple story simple marketing use advair or whatever you know simple court and your you know your pressure’s going to 280 oh it’s 50 what happened at least but i think that it is as you pointed out it’s a real problem it is not a
One-size-fits-all and when you look at therapy for copd it is frequently this combination of a long-acting bronchodilator ics that is not the appropriate therapy i know that’s what you were saying and what is the appropriate first airmen the appropriate thirst therapy i like to think of it as a hierarchy as you were starting the short-acting bronchodilators you a
Can add a long-acting or both classes of long-acting bronchodilator and then there are indications for going on to add other medications it is not an automatic then you just add ics if they are still not doing what now what are the things byron taught me have you did teach me something byron was that if you give a long-acting bronchodilator or a muscarinic drug you
Can actually shrink lung volumes over time which is if you will and forgive the oversimplification a chemical lung volume reduction that improves function so where does that fit here are they saying that is that what you’re hearing yes the okay so that the two bronchodilators the lobby lama combination which which i happen to like a lot and then i can defend that
Scientifically but i i don’t want to go off on that you might have to pugilistica lee here eventually put your finger on what it does the most important thing is the shortness of breath is driven by the air trapping a hyperinflation that’s why i like it because if you don’t respond to one the other ones there there’s no escalation in side-effects when you put the
Two together sorry oh that’s a nice combination now what about the inhaled steroid love another very nice combination or even the triple therapy and goal gives us nice guidelines there’s an asthma copd overlap people with a lot of via sinha fills as markers of allergic inflammation 300 cells per cubic millimeter there’s a lot of little and those are people people
With severe disease and most importantly people who have a lot of exacerbations the frequent fliers they need that steroid and so to make it pretty simple mono therapy with a long-acting agent and maybe dual bronchodilators and then either the triple or just ics lava let me a layer of complication i think the message here is copd is a treatable disease yeah it can
Be treated and these bronchodilators have changed the natural history important function quality of life so the foundation is long-acting bronchodilators most of the time now i use in the fixed combination on active because you give two to three different mechanism for the price of one you know that when it comes down and it’s and there’s no increased side effects
At least that’s a really important message that i don’t think primary care still hears all the time is you’re using two long-acting bronchodilators but they are different mechanisms of action so yes you use them together and they’re synergistic
Transcribed from video
Overview of COPD Medications By HCPLive