New Strategies for Managing COPD in Chronic Patients

According to an educational session at the ASHP 2017 Midyear Meeting, both old and new approaches can be used in combination to successfully manage chronic obstructive pulmonary disease (COPD).

The presentation by Lori Wilken, PharmD, Clinical Assistant Professor at the University of Illinois at Chicago College of Pharmacy and Clinical Pulmonary Pharmacist, and Dennis M Williams, PharmD, associate professor and vice chair at the division of pharmacotherapy and experimental therapeutics in the UNC Eshelman School of Pharmacy and Clinical Specialist for Pulmonary Medicine at the UNC Medical Center, was titled “Chronic Obstruc ve Pulmonary Disease: New Approaches to an Old Problem.”

Drs Wilken and Williams started their presentation by reviewing clinic trial data of newly approved COPD therapies. The highlighted the FLAME clinical trial, a study that helped support a clinical guideline approach to COPD treatment. The trial compared the Ultibro Breezhaler (indacaterol/glycopyrronium; Novartis) vs Advair Diskus (salmeterol/fluticasone; GlaxoSmithKline).

The study showed that exacerbation rates were 11% lower with Ultibro compared to Advair. Time to first exacerbation was also reduced in the Ultibro group, along with incidence of pneumonia.

They also highlighted the FULFIL study, which measured the efficacy of once-daily triple therapy in patients with COPD. The study compared the Breo Ellipta (fluticasone/furoate/vilanterol; GlaxoSmithKline) to Symbicort (budesonide/formoterol; Astrazeneca).

The study found that the triple therapy, Breo, reduced exacerbations by 35%.

Drs Wilken and Williams also highlighted a study that compared use of multiple inhalers with different technologies, and their impact on COPD management. The cited data showing that patients who use inhalers with different technologies and administration techniques are at risk for worse outcomes than patients who use inhalers with similar design.

According to the presentation, the best medication principles for optimal COPD management are making sure that bronchodilators are the focus of therapy, using long-acting bronchodilators for patients with chronic symptoms, and long acting muscarinic antagonist should be used to reduce exacerbation risk and hospitalization.

The presenters noted that the audience should consider certain value-based purchasing issues when prescribing COPD therapies. They noted that health systems are penalized for readmissions under these contracts, and COPD therapies can be used to reduce readmissions.

“Transition of care strategies are effective for reducing hospital readmissions and improving overall outcomes in COPD patients,” Drs Wilken and Williams said.

They concluded that dual bronchodilator therapy is a new strategy that benefits patients at highest risk for COPD exacerbations. Furthermore, they suggested de-escalation of pharmacotherapy as a new strategy gaining popularity in COPD management—with significant therapeutic and cost benefits.

—David Costill

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