Chronic Obstructive Pulmonary Disease: Whats New in Therapeutic - - PDF document

Chronic Obstructive Pulmonary Disease: What’s New in Therapeutic Management?

Sabrina Sherwood,PharmD • PGY2 Internal Medicine Pharmacy Resident • University of Utah Health • Sabrina.Sherwood@hsc.utah.edu

Table 1. Severity of Airflow Limitation

Severity Postbronchodilator FEV1 GOLD 1 (Mild) ≥ 80% predicted GOLD 2 (Moderate) ≥ 50% to < 80% predicted GOLD 3 (Severe) ≥ 30% to < 50% predicted GOLD 4 (Very severe) < 30% predicted

Table 2. ABCD Assessment

Commonly used Maintenance Inhalers in COPD (Available in the United States)

Generic name Brand name Device Usual dose LABA Salmeterol Serevent Diskus Twice daily Formoterol Foradil Aerolizer Twice daily Aformoterol Brovana Nebulizer Twice daily Indacaterol Arcapta Neohaler Once daily Olodaterol Striverdi Respimat Once daily Vilanterol Breo Ellipta Once daily LAMAs Tiotropium Spiriva Respimat/HandiHaler Once daily Aclidinium Tudorza Pressair Twice daily Umeclidinium Incruse Ellipta Once daily Glycopyrrolate Seebri Neohaler Twice daily LAMA/LABA Tiotropium/olodanterol Stiolto Respimat Once daily Umeclidinium/vilanterol Anoro Ellipta Once daily Glycopyrrolate/indacaterol Utibron Neohaler Twice daily Glycopyrrolate/formoterol Bevespi Aerosphere Twice daily LABA/ICS Formoterol/budesonide Symbicort Turbuhaler Twice daily Formoterol/mometasone Dulera HFA Twice daily Salmeterol/fluticasone Advair Diskus/HFA Twice daily Vilanterol/fluticasone furoate Breo Ellipta Once daily LABA/LAMA/ICS Fluticasone furoate/vilanterol/umeclidinium Trelegy Ellipta Once daily

References

1. Image on Slide 1: Image from Flickr. Available at https://flic.kr/p/arqkEh. Accessed July 20, 2018. 2. Thun MJ, Carter BD, Feskanich D, et al. 50-Year Trends in Smoking-Related Mortality in the United States. The New England journal of

• medicine. 2013;368(4):351-364. doi:10.1056/NEJMsa1211127.

3. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease (2018). Accessed July 2018. 4. COPD Assessment Test. GlaxoSmithKline. 2016. Available at: http://www.catestonline.org/english/indexEN.htm 5. Gentry S, Gentry B. Chronic Obstructive Pulmonary Disease: Diagnosis and Management. Am Fam Physician. 2017 Apr 1;95(7):433-441. 6. National Clinical Guideline Centre. (2010) Chronic obstructive pulmonary disease: management of chronic obstructive pulmonary disease in adults in primary and secondary care. London: National Clinical Guideline Centre. 7. Wedzicha JA, Miravitlles M, Hurst JR, et al. Management of COPD exacerbations: a European Respiratory Society/American Thoracic Society guideline. Eur Respir J. 2017 Mar 15;49(3). pii: 1600791. 8. Lexi-Drugs Online. Hudson, OH: Lexi-Comp, Inc; 2018. 9. Truth initiative. 2016. Image available at: https://truthinitiative.org/tobacco-use-idaho

• 10. McKesson. Pneumovax 23. Image available at: https://mms.mckesson.com/product/911398/Merck-00006483703
• 11. Health Status Research. St. George’s Respiratory Questionnaire. Accessed September 2018. Available at:

http://www.healthstatus.sgul.ac.uk/sgrq

• 12. Lipson DA, Barnacle H, Birk R, et al. FULFIL Trial: Once-Daily Triple Therapy for Patients with Chronic Obstructive Pulmonary Disease. Am J

Respir Crit Care Med. 2017 Aug 15;196(4):438-446.

• 13. Martinez FJ, Rabe KF, Sethi S, et al. Effect of Roflumilast and Inhaled Corticosteroid/Long-Acting β2-Agonist on Chronic Obstructive

Pulmonary Disease Exacerbations (RE(2)SPOND). A Randomized Clinical Trial. Am J Respir Crit Care Med. 2016 Sep 1;194(5):559-67.

• 14. Magnussen H, Disse B, Rodriguez-Roisin R, et al; Withdrawal of inhaled glucocorticoids and exacerbations of COPD (WISDOM). N Engl J
• Med. 2014 Oct 2;371(14):1285-94.
• 15. Uzun S, Djamin RS, Kluytmans JA, et al. Azithromycin maintenance treatment in patients with frequent exacerbations of chronic
• bstructive pulmonary disease (COLUMBUS): a randomised, double-blind, placebo-controlled trial. Lancet Respir Med. 2014

May;2(5):361-8.