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3yr
The importance of treating COPD early

Early COPD can refer to the destruction/loss of the terminal/transitional bronchioles that arises before a deterioration in lung function is demonstrated. It can manifest in the absence of emphysematous destruction, with surviving airways exhibiting narrowed lumens/thickened walls. Defining “early COPD” can be challenging, with the 2023 Global Initiative for Obstructive Lung Disease (GOLD) guidelines preferring a “biologic” to “clinical” definition.

According to the 2023 Global GOLD guidelines, all COPD patients can be started on a long-acting muscarinic antagonist (LAMA), with treatment increases as needed. Treatments should be tailored based on patient needs. Furthermore, the report recommends LAMA plus long-acting beta-agonist (LABA) as initial treatment option in Group B and Group E COPD patients, with single inhalers being a more convenient/effective option than multiple inhalers.

Data suggest that the LAMA, tiotropium bromide, enhances lung function, slows annual declines in FEV, and decreases the need for rescue inhalers. Moreover, findings from short- and long-term randomized, controlled clinical trials involving tiotropium use in COPD patients have suggested that it is safe and improves health-related quality of life and exercise endurance when compared with placebo or active comparators. It also reduces dyspnea and lung hyperinflation.

Tiotropium bromide inhalation spray is the only LAMA that delivers a soft mist designed to be gentler on damaged lungs because use of the soft mist inhaler (SMI) requires minimal inspiratory effort vs. other inhaler types.

What is your protocol for initiating early treatment in COPD patients? What have your experiences been with tiotropium bromide soft mist inhalation spray?

  • 3yr
    Usually follow latest or LABA for Group A,preferably Spiriva Respimat. Dual therapy for Group B.Triple therapy for Group E. SABA for rescue therapy. Daliresp,Zithromax,and O2 for severer stages.Include formal pulmonary rehabilitation early.
  • 3yr
    Try to help patient quit smoking if still smoking. Most patient need quick acting inhaler like albuterol. Daily maintenance therapy with LAMA can be very helpful. Tiopropium is effective medication which patient find easy to use.
  • 3yr
    For my patients with COPD who need maintenance therapy, I usually start with a LAMA, and Spiriva respimat is my first choice, effective, once daily and good coverage. Also I have good experience with it for the last several years. My next line is LAMA/LABA either Anoro or Spiriva with LABA.
    Next step is open or closed triple therapy, I prefer Trelegy and
    Bretztri, but if coverage is an issue then I go with triple therapy. Of course I give them all SABA to use as needed.
  • 3yr
    I frequently prescribe Spiriva respimat. It is very effective and usually referred by my patients.
  • 3yr
    RICHARD NGUYEN, DO
    MARCH 14, 2023

    Formaintenance of COPD< I usually start with a LAMA, and tiotropium is often my first choice becase of my familiarity with it. It is a favorite of my patients because of how well it woriks. My COPD patients can use albuterol prn. Alternatively, I can go with a LAMA/LABA such as Anoro, which also works great. Triple therapy such as Trelegy or Bretztri is the great next step in preventing COPD exacerbations although prior auth is often an obstacle.
  • 3yr
    It depends on the severity. I may start with Spiriva, or go with a LAMA/LABA, such as Anoro
  • 3yr
    I usually initiate therapy with the tiotropium respimat + albuterol prn, or a LABA/LAMA mostly Anoro due to it's favorable formulary coverage.
  • 3yr
    i have Started with spiriva for years, the fine mist has a much smaller particle size that gets further down into the respiratory tree. It’s quick and super easy to use. Only once symptoms or disease progress do i switch to stiolto ie lama/laba. My patients always comment on how much better they feel with spiriva, in my area there is never an issue witgetting this drug approved without a prior auth.
  • 3yr
    as above
    I start with lama first like tiotropium or incruse , then if patients still experiencing symptoms , I will switch to lama/laba or triple therapy like breztri or trelegy.
  • 3yr
    Tiotropium has worked well for my patients and I initiate it along with long acting beta agonist after failure of short acting beta agonists
  • 3yr
    I usually start with a LAMA…
    The Tiotropium respimat works very well!
  • 3yr
    I use LAMA majority of times as first option for COPD maintenance. Tiotropium has worked great in most patients I have tried it. The soft mist inhalation spray has improved patient adherence some. However coverage has been an issue in some situations
  • 3yr
    I try to adhere to the GOLD guidelines and usually initiate a LAMA. I find most have been using SABA, so I tend to already introduce a LAMA/LABA combination production to reduce the use of the SABA. Many times product choices are limited by formularies and paperwork in the form of prior authorizations. When I can get the Tiotropium SMI approved, most patient tend to prefer it. I am told they feel they are 'getting the medicine' as opposed to other inhalers. It is described as similar to using a nebulizer and requires minimal effort with inhalation.

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