Clinical practice guideline released on pharmacologic management of COPD
The American Thoracic Society strongly recommended LABA/LAMA combination therapy over monotherapy with either agent in patients with chronic obstructive pulmonary disease (COPD) and dyspnea or exercise intolerance, among other guidance.
Patients with chronic obstructive pulmonary disease (COPD) who have dyspnea or exercise intolerance should be treated with long-acting beta2-agonist (LABA)/long-acting muscarinic antagonist (LAMA) combination therapy rather than LABA or LAMA monotherapy, according to a new clinical practice guideline.
The guideline, which was developed by an expert task force on behalf of the American Thoracic Society, also conditionally recommended triple therapy with inhaled corticosteroids, a LABA, and a LAMA over LABA/LAMA dual therapy in patients with COPD and dyspnea or exercise intolerance who have had at least one exacerbation in the past year. Withdrawal of inhaled corticosteroids is conditionally recommended in patients receiving triple therapy who have had no exacerbations in the past year, the guideline said.
The guideline did not recommend for or against inhaled corticosteroids as an additive therapy to long-acting bronchodilators in patients with COPD and blood eosinophilia. However, in patients with COPD and blood eosinophilia who have had at least one or more exacerbation in the past year requiring antibiotics or oral steroids or hospitalization, inhaled corticosteroids are conditionally recommended as an additive therapy, the guideline said.
The guideline conditionally recommended against maintenance therapy with oral corticosteroids in patients with COPD and a history of severe and frequent exacerbations. Opioid-based therapy with personalized shared decision making was conditionally recommended in patients with COPD who continue to experience advanced refractory dyspnea despite otherwise optimal therapy.
The task force noted that additional research is needed in several populations that are underrepresented in clinical trials, including patients ages 80 years and older, patients with several chronic health conditions, and patients who have both COPD and asthma. The guideline updates the American Thoracic Society's 2011 guideline on this topic and was published April 13 by the American Journal of Respiratory and Critical Care Medicine.