Emerging Inhalation Treatments for COPD

Chronic obstructive pulmonary disease (COPD) is an airways disorder, characterised by airflow obstruction, resulting from alveolar septal wall destruction causing emphysema, and chronic bronchitis. It is a currently a leading cause of death worldwide, and its burden is expected to rise in the coming years. 

Common COPD symptoms include dyspnea, cough and/or sputum production. Some patients may experience acute worsening of symptoms, known as an exacerbation, and require additional therapy. Exacerbations are mainly triggered by respiratory infections and environmental factors. The predominant cause for COPD is cigarette smoking. Indoor and outdoor air pollution, occupational hazards, and infections, are also important causative agents for COPD.

Pharmacologic therapy for COPD

COPD is a complex pulmonary condition with several underlying molecular mechanisms. These mechanisms not only differ from patient to patient but also within the same patient as the disease progresses. Therefore, therapy is made in a way to address these complexities. Currently used therapeutics involve combination of following drugs:

• Bronchodilators - Either short acting or long acting and ultra-long acting
  • e.g. Albuterol, Terbutaline or Formoterol and Indacaterol, Vilanterol, Olodaterol
• Anti-muscarinics - Either short acting or long acting
  • Ipratropium or Tiotropium, Umeclidinium
• Inhaled corticosteroids – e.g. Fluticasone furoate

The Global Initiative for Chronic Obstructive Lung Disease (GOLD), recommends inhalation therapy as the preferred route of drug administration for treating COPD. Inhalation devices consist of nebulizers and handheld inhalers, such as dry-powder inhalers, pressurized metered-dose inhalers, and soft mist inhalers. Rescue medication with short-acting bronchodilators are prescribed for immediate symptom relief, but use of these is not generally recommended on a regular basis and therefore, long-acting drugs are prescribed. Evidence is emerging that combinations of above 3 classes have a synergistic rather than just an additive effect. Examples of prescription medication used for COPD include:

STIOLTO RESPIMAT - An Inhaler that contains 2 drugs namel: tiotropium bromide and olodaterol
Stiolto Respimat is a steroid free maintenance medication. It is not for treating sudden symptoms of COPD. It is always have a rescue medicine with you to treat sudden attacks.

TRELEGY ELLIPTA – Inhaler with three drugs namely, fluticasone furoate, umeclidinium, and vilanterol. Trelegy is also a maintenance medication and cannot be used to relieve sudden breathing problems.