Research – GlaxoSmithKline, Boerhringer Ingelheim, Sanofi, AstraZeneca, Teva

Research – GlaxoSmithKline, Boerhringer Ingelheim, Sanofi, AstraZeneca, Teva

• Research – GlaxoSmithKline, Boerhringer Ingelheim, Sanofi, AstraZeneca, Teva

• Consulting – Teva, GSK

• Speaking – AstraZeneca, Sunovion

Address access and adherence to meds

• Address access and adherence to meds

• Choose most potent bronchodilators

• LAMAs modestly more potent than LABAs in COPD

• Combine bronchodilators with different mechanisms

• LAMA/LABA appears to be most potent bronchodilator combination

• Add anti-inflammatories to bronchodilators for additional control

• ICS+LABA or ICS+LABA+LAMA
• Phosphodiesterase inhibitors (roflumilast)
• Chronic azithromycin

• Consider low dose theophylline

Hippocrates circa ~ 500 BC

• Hippocrates circa ~ 500 BC

• “Keep a watch also on the faults of the patients, which often make them lie about the taking of things prescribed”

• Dr Pill circa 2018 AD

• “Sometimes it’s not the patient’s fault, affordable access to medicines is most frequent cause for non-adherence”

Peak Inspiratory Flow Rate (matters with DPIs) Decreases With

• Peak Inspiratory Flow Rate (matters with DPIs) Decreases With

• COPD Exacerbations

• And Can be Suboptimal in Some Patients Even When Stable

IV or oral dexamethasone similar or slightly less effective in AECOPD

• IV or oral dexamethasone similar or slightly less effective in AECOPD

• Benefit is minimal mineralcorticoid effect compared to prednisone
• More immune suppression
• Don’t use in prednisone-dependent patient

• High-dose nebulized budesonide

Budesonide doses have ranged from 2 mg BID to 4 mg TID (can mix with albuterol in nebulizer)

• Budesonide doses have ranged from 2 mg BID to 4 mg TID (can mix with albuterol in nebulizer)

• Administered by high-efficiency nebulizers as Pari LC Plus®

• 7 days more effective than < 5 days

• Don’t use if patient prednisone-dependent due to potential for adrenal crisis

Quinolones

• Quinolones

• ”Most broad spectrum” for ECOPD, but the least safe
• Mental status changes – especially cipro
• Prolonged QTc, esp moxifloxacin
• Hypo- and hyperglycemia
• Lots of drug and food interactions

• Macrolides

• Poor gram negative, but safer than quinolones
• Pneumococcal resistance, but not as common as with community-acquired pneumonia
• Low blood levels, not good if concerned about bacteremia
• Concern about CV safety of azithromycin is disproportionate to actual risk
• Drug interactions not a major issue with azithromycin