This will include discontinuing the individual component therapies once the FDC medicine is started. 1 Refer to guidelines for addition of therapies as stated above. Place of combination bronchodilators in management of COPDįDC bronchodilators can simplify COPD treatment regimens by combining two separate medicines in a single device.
The Lung Foundation of Australia offers the Stepwise Management of Stable COPD resource, 2 which includes a visual Check guidelines for recommendations about combination therapy before adding an inhaler. 4 Key points to remember when adding therapies are: 2ĭo not double-up inhalers containing an anticholinergic (SAMA or LAMA or LABA/LAMA fixed-dose combination )ĭo not double up inhalers containing a LABA (LABA or LABA/ ICS or LABA/LAMA FDC)Ī SABA may be used alongside all inhalers for symptom relief.Īpplying these guidelines in stepwise management of COPD means certain medicines need to be discontinued before starting others. While therapy combinations need to be patient specific, some classes of medicines should not be used together. 1 Regimens are guided by the severity of symptoms, risk of exacerbations and the patient’s response. However, there is limited evidence on the best choice of combinations of medicines for COPD management. 1, 2, 4Ĭombining bronchodilators of different classes may improve efficacy and decrease risk of side effects compared with increasing the dose of a single bronchodilator. 3, 4Ĭonsider adding theophylline in patients with severe COPD for whom other treatments have failed to control symptoms adequately. There is some evidence to support triple therapy (LABA + LAMA + ICS) improving lung function and quality of life, but more studies are required. ≤ 50% predicted and two or more exacerbations requiring treatment in the previous year). Long-acting bronchodilators include beta-2 agonists (LABAs) or anticholinergics/muscarinic antagonists (LAMAs).Ĭombination therapy with an inhaled corticosteroid (ICS) and a LABA is indicated for patients who remain symptomatic after treatment with long-acting bronchodilators ( FEV 1 Pharmacological interventions typically involve starting treatment with a short-acting reliever (either a short-acting beta-2 receptor agonist or a short-acting anticholinergic/muscarinic receptor antagonist ) as needed for symptom relief, before adding maintenance therapy with one or Non-pharmacological interventions such as smoking cessation, weight control, exercise and pulmonary rehabilitation are an important part of COPD management at every stage. Management of stable COPD requires a stepwise approach.
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