COPD Stakeholder Summit: Utilizing Peak Inspiratory Flow Rates to Individualize Treatment and Improve Outcomes - Episode 4

Treatment Options for COPD

A broad overview of the overall approach to managing chronic obstructive pulmonary disease with available treatment options.

Neil Minkoff, MD: Dr Mahler, I’m going to pivot over to you for a minute. We’ve been talking a lot about the different types of medications that could be used, the different types of inhalers, and so on. Just to make sure everybody who’s watching or engaging with us is together on this, could you talk about some of the main drug classes that are used for the chronic management of COPD [chronic obstructive pulmonary disease] and touch on efficacy, safety, and things like that?

Donald A. Mahler, MD: Sure. There are 2 major classes of medications: bronchodilators and inhaled corticosteroids. Within the bronchodilator class, we have 2 distinct medications. One group is called beta-agonists. The other is called muscarinic antagonists. Those reflect the mechanisms of action whereby each of these classes relax bronchial smooth muscle to open up the airways, dilate the airways, make it easier to breathe, and possibly help people cough out mucus or phlegm. Inhaled corticosteroids are the other category. These days we can prescribe these as individual medications, or more frequently, we use combination therapies with either 2 or 3 in a single inhaler.

You asked about the starting point. Where do we start with medications? For about 90% of our patients with COPD, we typically prescribe a maintenance medication, a maintenance inhaler. That would be taken either once or twice a day because these are long-acting medications. We should also prescribe a rescue inhaler that can be used as needed, either when people are having difficulty breathing or when they’re going to do an activity that might provoke or bring on shortness of breath. That’s a brief summary of the overall approach that we have available.

Neil Minkoff, MD: Are there any concerns about safety with any of those drugs?

Donald A. Mahler, MD: With any medication, we have to balance the benefit and possible [adverse] effects or risks with the medication. Yes, there are some potentially serious [adverse] effects from medicines. If used in appropriate dose and appropriate frequency, they’re typically fairly minimal. I don’t know if you want to get into details about possible [adverse] effects with each of the classes of medications or let that go.

Neil Minkoff, MD: Do you think there’s anything crucial to highlight?

Donald A. Mahler, MD: I don’t think so. I think the vast majority of our patients tolerate these medications fairly well. Yes, we can talk about small risks of [adverse] effects, particularly based on maybe someone’s comorbidities or what else is going on. But these are things that I discuss with patients before I prescribe a particular inhaler. I tell them the reason I’m prescribing it, which is mainly to relieve symptoms, shortness of breath, and reduce the risk of exacerbations if they’re in the high-risk category. Then I also discuss common possible [adverse] effects and say, “We have to give it a try and see how things go.” Again, balancing benefits vs [adverse] effects.


This activity is supported by an educational grant from Boehringer Ingelheim.