Combination Therapy Options in Stable COPD

Christie Choo, PharmD, BCPS

Disclosures

US Pharmacist. 2010;35(7):1-4. 

In This Article

Abstract and Introduction

Introduction

It is predicted that by 2020, chronic obstructive pulmonary disease (COPD) will become the third most common cause of death in the world.[1] Yet currently, there are only a number of treatment modalities that have demonstrated long-term improvement of lung function.[2] These include smoking cessation, oxygen supplementation in hypoxic patients, and lung volume reduction surgery in emphysemic patients. Inhaled bronchodilators and corticosteroids are the mainstay of COPD treatment; however, their efficacy is limited to preventing exacerbations and alleviating symptoms. Considering the current trajectory of COPD mortality and morbidity, it is imperative that we seek pharmacologic options that may play a role in reducing the burden of COPD. Presently, the data in regard to improving outcomes are especially encouraging with combination therapies.

This article will examine the evidence supporting the use of combination therapy of beta agonists with muscarinic antagonists and/or corticosteroids. The data supporting the use of tiotropium as the muscarinic agent of choice will also be highlighted, although no commercially made tiotropium/beta agonist fixed-combination product is available. This is due to the shorter duration of activity of currently available beta agonists, which are dosed every 4 to 12 hours, whereas tiotropium is dosed once daily.[2]

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