Medical Chronicle hosted a CPD-accredited webinar on improving COPD outcomes, sponsored by Cipla and presented by Prof Guy Richards. This article summarises highlights from his talk. 

Over 80 million people suffer from moderate-to-severe chronic obstructive pulmonary disease (COPD).

To view the webinar recording and still earn a CPD point, visit: https://event.webinarjam.com/replay/770/w8948cog4brpguo41f76rk 

Medical Chronicle hosted a CPD-accredited webinar on improving COPD outcomes, sponsored by Cipla and presented by Prof Guy Richards. This article summarises highlights from his talk. Asthma, a heterogeneous disease characterised by chronic airway inflammation, presents with respiratory symptoms like wheezing, shortness of breath, chest tightness, and cough, along with variable expiratory airflow limitation (GINA, 2017). COPD, a common, preventable, and treatable disease, is marked by persistent respiratory symptoms and airflow limitation due to airway and/or alveolar abnormalities, typically from significant exposure to harmful particles or gases (GOLD 2017). 

Asthma-COPD overlap (ACO), characterised by persistent airflow limitation with features of both asthma and COPD, is identified clinically by its shared features. This is not a strict definition but a clinical description, encompassing various phenotypes and mechanisms. 

COPD mortality 

Over 80 million people have moderate-to-severe COPD, with half dying within ten years of diagnosis. In 2012, COPD claimed three million lives. 

GOLD: Goals of therapy 

Reduce symptoms: 

• Relieve symptoms
• Improve exercise tolerance
• Improve health status.

Reduce risk: 

• Prevent disease progression
• Prevent and treat exacerbations
• Reduce mortality.

Bronchodilator therapy deflates the lungs, improving airflow. Forced expiratory volume (FEV1) measures how much air one can force out in one second.  

Bronchodilator therapy improves volumes like forced vital capacity (FVC) and inspiratory capacity (IC). 

Bronchodilators are central to managing stable COPD symptoms. Short-acting beta agonists (SABAs) and short-acting muscarinic antagonists (SAMAs) provide symptom relief. 

Combination therapies 

• Long-acting bronchodilator combinations (LABAs) and long-acting muscarinic antagonists (LAMAs) significantly improve pulmonary function tests (PFT), shortness of breath (SOB), quality of life (QOL), and reduce acute exacerbations (AE)
• LAMAs decrease AE and hospitalisations compared to LABAs Combination LAMA/LABAs increase FEV1 and reduce symptoms and AEs compared to monotherapy.

Tiotropium enhances exercise performance during rehabilitation. 

LABA/LAMA combinations 

For COPD not controlled on one bronchodilator, combining two with different mechanisms may lower doses, reduce adverse effects, simplify regimens, and improve compliance. LABA/LAMA combinations offer greater bronchodilation and better patient-reported outcomes: 

• Superior to LABA, LAMA, or LABA and inhaled corticosteroids (ICS) in reducing hyperinflation
• Long-acting β2-agonist indacaterol/long-acting muscarinic antagonist glycopyrronium (IND/GLY) is superior to IND alone in increasing IC
• IND and the LAMA tiotropium (TIO) surpass TIO alone in improving IC
• LABAs formoterol (FORM) and TIO significantly reduce end-expiratory lung volume (EELV) versus FORM.

Single inhaler triple therapy 

An observational study on single-inhaler triple therapy vs dual bronchodilators in real-world clinical practice (UK’s Clinical Practice Research Datalink) showed: 

• Patients starting single-inhaler triple therapy (n=4106), or single-inhaler dual bronchodilator (n=29,702) were followed for one year; hazard ratio (HR) of first moderate or severe AE on triple vs dual was 1.08 (1.00–1.16)
• AE risk was lower with triple therapy in patients with ≥2 prior exacerbations, a prior asthma diagnosis, and blood eosinophil count >300 cells/µL
• Severe pneumonia (HR 1.50, 95% CI 1.29–1.75) increased with triple therapy.

Treatment essentials 

Smoking cessation (including cannabis) is crucial. Pharmacotherapy reduces symptoms, frequency, severity of AEs, and improves health-related quality of life. Individualised pharmacotherapy, considering the ABE classification system, cost, response, preference, and device, is important.  

Regularly assess inhaler technique. Influenza and PCV13 vaccines lower respiratory tract infection rates. Physical rehabilitation improves symptoms and health-related quality of life.