1įluticasone furoate/Umeclidinium/VilanterolĪbbreviations: COPD = chronic obstructive pulmonary disease HFA = hydrofluoroalkane ICS = inhaled corticosteroid LABA = long-acting beta-2 agonist LAMA = long-acting muscarinic antagonist (or anticholinergic) MDI = metered-dose inhaler Neb = nebulizer solution. ( Symbicort, generics Symbicort Turbuhaler )Ĭombination ICS/LAMA/LABA: Consider for patients with severe or very severe COPD with continued frequent and/or serious exacerbations despite optimized use of LABA and LAMA or LABA/ICS. 1 Chronic ICS use increases pneumonia risk in patients with severe COPD. May be used first line in patients with blood eosinophil counts of about 4% (300 cells/mcL ) or more, or in patients who also have asthma. 1,4 Patients with eosinophil counts of less than about 2% (100 cells/mcL ) may not benefit from ICS. ![]() 1 Patients with blood eosinophil counts of about 2% (100 cells/mcL ) or more have been shown to have benefit with the addition of an ICS. ( Stiolto Respimat , Inspiolto Respimat )Ĭombination LABA/ICS: Consider when exacerbations continue despite appropriate long-acting bronchodilator therapy. ( US: Lonhala Magnairnebulizer solution Canada: Seebri Breezhaler) ![]() Glycopyrrolate (also called Glycopyrronium) Long-Acting Muscarinic Antagonists (LAMAs) ( US: Perforomist nebulizer solution, generics Canada: Foradil) 1 LAMAs are superior to LABAs in preventing exacerbations and possibly hospitalizations, so may be preferred in patients with two or more exacerbations or at least one hospitalization in the last year. 1 Add a LAMA to a LABA (or vice versa) if one does not control symptoms. 1 Therapy can start with one or two long-acting bronchodilators (depending on severity of symptoms and exacerbations). Long-Acting Beta-2 Agonists (LABAs) and Long-Acting Muscarinic Antagonists (LAMAs): First-line option for patients with persistent symptoms despite use of a short-acting brochodilator. MDI: Four times daily (in place of long-acting bronchodilator), and/or as needed. ( Atrovent HFA, Ipravent, generics)Ĭanada: MDI $22/200 doses neb $160/120 dosesĬombination Beta-2 Agonist/Anticholinergic: Can use this combination to improve efficacy and/or limit adverse effects. ( US: ProAir HFA, ProAir RespiClick, ProAir Digihaler, Proventil HFA, Ventolin HFA, generics Ĭanada: Airomir, Ventolin Diskus, Ventolin HFA, generics) 1 Note that beta-2 agonists are also available as nebulizer solutions which may be less expensive but less convenient to use. 1 However, regular use of short-acting bronchodilators does improve symptoms and FEV1 in patients with COPD. ![]() 1,3 A long-acting bronchodilator (LABA or LAMA) is preferred to regular use of short-acting bronchodilator. 1 Can combine beta-2 agonists and ipratropium to improve efficacy and/or limit side effects.
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