A rational approach to single, dual and triple therapy in <scp>COPD</scp>

Calverley, Peter M.A.; Vlies, Ben

doi:10.1111/resp.12690

Cited by 18 publications

(22 citation statements)

References 82 publications

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“…Measurement of blood eosinophils may be a more useful biomarker for routine practice. The threshold for eosinophilic inflammation continues to be debated, with some reports suggesting a threshold of >2%, 3%, or 4% of the total white-blood-cell count, whereas others propose a total eosinophil count of 150, 220, or 300 cells/µL 45,46…”

Section: Predictors Of Responsementioning

confidence: 99%

“…Currently, GOLD guidelines provide recommendations for drug selection based on a patient’s symptom intensity and disease severity assessed by prior and future risk of exacerbations 1,45. ICS-LABA combinations have been shown to reduce exacerbations, improve lung function, and improve health status 14,26,28–30.…”

Section: Role Of Icss In Current Copd Treatmentmentioning

confidence: 99%

“…ICS-LABA combinations are thus recommended as a treatment option for COPD patients with a history of frequent exacerbations,1 but they are commonly prescribed as first-line treatments, regardless of COPD severity 38,74. Over the past 5 years, there has been an increase in new drugs and delivery devices, adding to the complexity of COPD treatment options 45. However, the data reviewed herein provide information to identify patient groups that may benefit from ICS use (Figure 2).…”

Section: Role Of Icss In Current Copd Treatmentmentioning

confidence: 99%

“…However, the data reviewed herein provide information to identify patient groups that may benefit from ICS use (Figure 2). Concerns with ICS use are related to the safety considerations described in the previous section and the potential risks associated with withdrawal of ICS therapy 45,74,78. Long-term adverse events described in some studies are complicated by concomitant oral CS use and confounding disease severity, as well as comorbidities.…”

Section: Role Of Icss In Current Copd Treatmentmentioning

confidence: 99%

“…It is important that exacerbations be differentiated from other events that may be related to common comorbidities of COPD, including acute coronary syndrome, worsening congestive heart failure, pulmonary embolism, and pneumonia 1. Although for many years it was believed that stopping ICS use could trigger an exacerbation, it has recently been shown that withdrawal of ICSs is possible, particularly when other medications are introduced concomitantly 45. In the Withdrawal of Inhaled Steroids during Optimized Bronchodilator Management (WISDOM) study, ICS therapy was withdrawn gradually over 12 weeks from a triple combination, without an overall increased risk of exacerbations compared with the group that remained on triple therapy (HR 1.06, 95% CI 0.94–1.19) 79.…”

Section: Role Of Icss In Current Copd Treatmentmentioning

confidence: 99%

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Inhaled corticosteroids for chronic obstructive pulmonary disease: what is their role in therapy?

Tashkin¹,

Strange²

2018

COPD

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Inhaled corticosteroids (ICSs) are a mainstay of COPD treatment for patients with a history of exacerbations. Initial studies evaluating their use as monotherapy failed to show an effect on rate of pulmonary function decline in COPD, despite improvements in symptoms and reductions in exacerbations. Subsequently, ICS use in combination with long-acting β2-agonists (LABAs) was shown to provide improved reductions in exacerbations, lung function, and health status. ICS-LABA combination therapy is currently recommended for patients with a history of exacerbations despite treatment with long-acting bronchodilators alone. The presence of eosinophilic bronchial inflammation, detected by high blood eosinophil levels or a history of asthma or asthma–COPD overlap, may define a population of patients in whom ICSs may be of particular benefit. Prospective clinical studies to determine an appropriate threshold of eosinophil levels for predicting the beneficial effects of ICSs are needed. Further study is also required in COPD patients who continue to smoke to assess the impact of cell- and tissue-specific changes on ICS responsiveness. The safety profile of ICSs in COPD patients is confounded by comorbidities, age, and prior use of systemic corticosteroids. The risk of pneumonia in patients with COPD is increased, particularly with more advanced age and worse disease severity. ICS-containing therapy also has been shown to increase pneumonia risk; however, differences in study design and the definition of pneumonia events have led to substantial variability in risk estimates, and some data indicate that pneumonia risk may differ by the specific ICS used. In summary, treatment with ICSs has a role in dual and triple therapy for COPD to reduce exacerbations and improve symptoms. Careful assessment of COPD phenotypes related to risk factors, triggers, and comorbidities may assist in individualizing treatment while maximizing the benefit-to-risk ratio of ICS-containing COPD treatment.

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Section: Predictors Of Responsementioning

confidence: 99%

Section: Role Of Icss In Current Copd Treatmentmentioning

confidence: 99%

Section: Role Of Icss In Current Copd Treatmentmentioning

confidence: 99%

Section: Role Of Icss In Current Copd Treatmentmentioning

confidence: 99%

Section: Role Of Icss In Current Copd Treatmentmentioning

confidence: 99%

See 3 more Smart Citations

Inhaled corticosteroids for chronic obstructive pulmonary disease: what is their role in therapy?

Tashkin¹,

Strange²

2018

COPD

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Pharmacokinetics of Co‐Suspension Delivery Technology Budesonide/Glycopyrronium/Formoterol Fumarate Dihydrate (BGF MDI) and Budesonide/Formoterol Fumarate Dihydrate (BFF MDI) Fixed‐Dose Combinations Compared With an Active Control: A Phase 1, Randomized, Single‐Dose, Crossover Study in Healthy Adults

Maes

DePetrillo²,

Siddiqui

et al. 2018

Clinical Pharm in Drug Dev

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This randomized, phase 1, single-dose, crossover study (NCT02189304) compared the 12-hour pharmacokinetic (PK) and safety profiles of budesonide/glycopyrronium/formoterol fumarate dihydrate metered dose inhaler (BGF MDI) 320/14.4/10 μg and budesonide/formoterol fumarate dihydrate (BFF) MDI 320/10 μg (both formulated using innovative co-suspension delivery technology) to an active comparator (budesonide/formoterol fumarate dihydrate dry powder inhaler [BUD/FORM DPI] 320/9-μg delivered dose) in healthy adults. The potential for PK interaction between glycopyrronium and budesonide/formoterol within BGF MDI was assessed. Of 72 subjects randomized, 59 completed treatment. Systemic budesonide exposure (primary objective) based on area under the plasma drug concentration-time curve 0-12 hours (AUC ; % coefficient of variation) was 1598.38 (49.7), 1657.09 (50.4), and 1276.75 (70.4) pg·h/mL for BGF MDI, BFF MDI, and BUD/FORM DPI, respectively; and formoterol exposure (AUC [% coefficient of variation]) was 39.16 (45.9), 39.53 (40.5), and 23.24 (59.2) pg·h/mL, respectively. BGF MDI and BFF MDI were bioequivalent for budesonide and formoterol. All treatments were well tolerated. While systemic exposure to budesonide and formoterol was higher for BGF MDI and BFF MDI than for BUD/FORM DPI, there were no appreciable differences in the incidence of pharmacologically predictable adverse events. This, coupled with the absence of PK interactions, suggests the BGF MDI safety profile will be comparable to BUD/FORM DPI.

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Chronic Obstructive Pulmonary Disease Individualized Therapy: Tailored Approach to Symptom Management

2016

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Chronic obstructive pulmonary disease (COPD) is associated with high morbidity and mortality. COPD is typified by persistent, progressive airflow limitation and a range of respiratory and systemic symptoms such as breathlessness, coughing, wheezing, depression, anxiety, general fatigue, and sleeping difficulties. Despite receiving treatment for COPD, many patients suffer from regular symptoms that affect their daily lives and lead to increased morbidity. These symptoms vary in severity, frequency, and type, and can occur at any time throughout the 24-h day, with over half of patients with COPD experiencing symptoms in the morning, during the day, and at nighttime. Despite the prevalence of symptoms, patient and physician perception of the impact of COPD symptoms on patients’ lives is not always in concordance. Dual bronchodilator therapy with a long-acting muscarinic antagonist (LAMA) and long-acting beta agonist (LABA) has the potential to treat the symptoms of COPD in addition to improving lung function. This review therefore examines the burden of symptoms experienced throughout the day by patients with COPD and the evidence for combined LAMA/LABA treatment in terms of symptom management. As patients with COPD experience varying symptoms throughout the course of their disease, the role of tailoring treatment to the individual needs of the patient is also examined. We conclude that the symptoms of COPD are troublesome, variable, can occur during all parts of the 24-h day, and have a substantial impact on patients’ health status and quality of life. In order to provide effective, patient-orientated care, patients with COPD should be evaluated on the basis of lung function, the frequency of symptoms, and patient-perceived impact of symptoms on their lives. Therapy should be chosen carefully based on individualized assessment, ensuring personalization to the individual needs of the patient.

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A rational approach to single, dual and triple therapy in COPD

Cited by 18 publications

References 82 publications

Inhaled corticosteroids for chronic obstructive pulmonary disease: what is their role in therapy?

Inhaled corticosteroids for chronic obstructive pulmonary disease: what is their role in therapy?

Chronic Obstructive Pulmonary Disease Individualized Therapy: Tailored Approach to Symptom Management

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