The Role of Fixed-Dose Dual Bronchodilator Therapy in Treating COPD

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Presentation transcript:

The Role of Fixed-Dose Dual Bronchodilator Therapy in Treating COPD Antonio Anzueto, MD, Marc Miravitlles, MD The American Journal of Medicine Volume 131, Issue 6, Pages 608-622 (June 2018) DOI: 10.1016/j.amjmed.2017.12.018 Copyright © 2018 The Authors Terms and Conditions

Figure 1 Global Initiative for Chronic Obstructive Lung Disease (GOLD) Treatment Recommendations for Patients According to Disease Severity and Risk (Reprinted with permission of the Global Initiative for Chronic Obstructive Lung Disease).4 FEV1 = forced expiratory volume in 1 second; ICS = inhaled corticosteroid; LABA = long-acting β2-agonist; LAMA = long-acting muscarinic antagonist. The American Journal of Medicine 2018 131, 608-622DOI: (10.1016/j.amjmed.2017.12.018) Copyright © 2018 The Authors Terms and Conditions

Figure 2 Algorithm for choosing an inhaler device according to the patient's inspiratory flow and ability to coordinate inhaler actuation and inspiration (Reprinted from Respir Med, 107, Dekhuijzen PN, Vincken W, Virchow JC, et al. Prescription of inhalers in asthma and COPD: towards a rational, rapid and effective approach, 1817–1821, Copyright 2013, with permission from Elsevier.).61 DPI = dry powder inhaler; pMDI = pressurized metered dose inhaler. The American Journal of Medicine 2018 131, 608-622DOI: (10.1016/j.amjmed.2017.12.018) Copyright © 2018 The Authors Terms and Conditions

Figure 3 Therapeutic recommendations based on exacerbation phenotype (Reproduced with permission from Miravitlles et al, 2017).70 There is a strong case for maximizing bronchodilation to reduce exacerbation risk in patients with COPD. For those who persist with exacerbations despite this, treatment according to their phenotype is recommended. COPD = chronic obstructive pulmonary disease; ICS = inhaled corticosteroid; LABA = long-acting β2-agonist; LAMA = long-acting muscarinic antagonist; mMRC = modified Medical Research Council dyspnea scale. The American Journal of Medicine 2018 131, 608-622DOI: (10.1016/j.amjmed.2017.12.018) Copyright © 2018 The Authors Terms and Conditions