FDA-Approved Chronic Obstructive Pulmonary Disease Treatment
| FDA-APPROVED CHRONIC OBSTRUCTIVE PULMONARY DISEASE TREATMENT* | |||
|---|---|---|---|
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• Risk Factors for COPD includes: genetic factors, exposure to particles (tobacco smoke, occupational dusts, outdoor air pollution), oxidative stress, respiratory infections, nutrition, comorbidities. • Classification º Stage 1: Mild – FEV1/FVC<0.70; FEV1≥80% predicted. º Stage 2: Moderate – FEV1/FVC<0.70; 50%≤FEV1<80% predicted. º Stage 3: Severe – FEV1/FVC<0.70; 30%≤FEV1<50% predicted. º Stage 4: Very Severe – FEV1/FVC<0.70; FEV1<30% predicted or FEV1<50% predicted + CRF. • Step-wise treatment – Visit the Global Initiative for Chronic Obstructive Lung Disease (GOLD) website at www.goldcopd.org for information about use of medications at various stages of COPD. |
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| Brand | Generic | Formulation | Usual Dosage |
| BRONCHODILATORS | |||
| β2-AGONISTS | |||
| LONG-ACTING | |||
| Arcapta Neohaler**† | indacaterol | caps | Adults: 1 inh of one 75mcg caps once daily, using Neohaler device. Do not
swallow caps.
Children: Not recommended. |
| Brovana** | arformoterol | solution | Adults: Inhale 15mcg twice daily (AM & PM) by nebulization (max: 30mcg/day).
Use standard jet nebulizer with air compressor (see literature).
Children: Not recommended. |
| Foradil Aerolizer | formoterol | DPI | Adults: 1 inh (12mcg) every 12hrs using Aerolizer inhaler (max: 24mcg/day)
Children: Not recommended. |
| Perforomist**† | formoterol | solution | Adults: One 20mcg vial twice daily (AM & PM) by oral inhalation via nebulizer
(max: 40mcg/day).
Children: Not recommended. |
| Serevent Diskus† | salmeterol | DPI | Adults: 1 inh (50mcg) twice daily (AM & PM) every 12hrs.
Children: Not recommended. |
| ANTICHOLINERGICS | |||
| SHORT-ACTING | |||
| Atrovent HFA | ipratropium bromide** | MDI | Adults: 2 inh 4 times daily (max: 12 inh/day).
Children: Not recommended. |
| Ipratropium Bromide Inh Solution | solution | Adults: 500mcg by oral nebulization 3–4 times daily every 6–8hrs.
Children: Not recommended. |
|
| LONG-ACTING | |||
| Spiriva HandiHaler** | tiotropium bromide | caps | Adults: 2 oral inhalations of one 18mcg caps once daily, using HandiHaler device.
Do not swallow caps.
Children: Not recommended. |
| COMBINATION THERAPY | |||
| Combivent** | albuterol + ipratropium | MDI | Adults: 2 inh four times daily (max: 12inh/day)
Children: Not recommended. |
| Combivent Respimat** | MDI | Adults: 1 inh 4 times daily (max: 6 inh/day).
Children: Not recommended. |
|
| Duoneb** | solution | ≥18yrs: 1 vial (3mL) 4–6 times daily via nebulizer.
<18yrs: Not recommended |
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| CORTICOSTEROIDS | |||
| COMBINATION THERAPY | |||
| Advair 250/50 Diskus†‡ | salmeterol + fluticasone | DPI | Adults: 1 inh of 250/50mcg twice daily.
Children: Not recommended. |
| Symbicort 160/4.5† | formoterol + budesonide | MDI | Adults: 2 inh of 160/4.5mcg twice daily.
Children: Not recommended. |
| OTHER | |||
| PDE4-INHIBITOR | |||
| Daliresp**† | roflumilast | tabs | Adults: One 500mcg tab once daily.
Children: Not recommended. |
| NOTES | |||
|
caps = capsules; COPD = chronic obstructive pulmonary disease; CRF = chronic respiratory failure; DPI = dry powder inhaler; FEV1 = forced expiratory volume in one second; FVC = forced vital capacity; hr = hour; inh = inhalation; mcg = microgram; MDI = metered dose inhaler; tabs = tablets. |
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*Not an inclusive list. Visit the website for the Global Initiative for Chronic Obstructive Lung Disease (GOLD) at www.goldcopd.org for information about use of medications at various stages of COPD. **Indicated only for COPD. †Not indicated for the relief of acute bronchospasm. ‡Only Advair 250/50 Diskus twice daily is approved for maintenance treatment of COPD because an efficacy advantage of the higher strength Advair 500/50 over Advair 250/50 has not been demonstrated. Other strengths and formulations of Advair are available. (Rev. 4/2013) |
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