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



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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

  • 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









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