Inhaled therapies in patients with moderate COPD in clinical practice: current thinking

Abstract

COPD is a complex, heterogeneous condition. Even in the early clinical stages, COPD carries a significant burden, with breathlessness frequently leading to a reduction in exercise capacity and changes that correlate with long-term patient outcomes and mortality. Implementation of an effective management strategy is required to reduce symptoms, preserve lung function, quality of life, and exercise capacity, and prevent exacerbations. However, current clinical practice frequently differs from published guidelines on the management of COPD. This review focuses on the current scientific evidence and expert opinion on the management of moderate COPD: the symptoms arising from moderate airflow obstruction and the burden these symptoms impose, how physical activity can improve disease outcomes, the benefits of dual bronchodilation in COPD, and the limited evidence for the benefits of inhaled corticosteroids in this disease. We emphasize the importance of maximizing bronchodilation in COPD with inhaled dual-bronchodilator treatment, enhancing patient-related outcomes, and enabling the withdrawal of inhaled corticosteroids in COPD in well-defined patient groups.

Keywords: LABA; LAMA; anticholinergic; dual bronchodilation; inhaled corticosteroid; tiotropium.

Figure 1

Estimated changes in FEV₁ by GOLD group and severe-exacerbation status. Notes: The plot demonstrates that for each GOLD classification, those individuals with at least one severe exacerbation (dotted lines) had faster declines in FEV₁ on average compared with those who did not (solid lines). GOLD 0, no airway obstruction; GOLD 1, mild; GOLD 2, moderate; GOLD 3, severe; GOLD 4, very severe. Reprinted with permission of the American Thoracic Society. Copyright © 2017 American Thoracic Society. Dransfield MT, Kunisaki KM, Strand MJ, et al. 2017 Acute exacerbations and lung function loss in smokers with and without COPD. Am J Respir Crit Care Med. 2017;195:324–330. The American Journal of Respiratory and Critical Care Medicine is an official journal of the American Thoracic Society. Abbreviation: PRISm, preserved ratio-impaired spirometry.