Management of chronic obstructive pulmonary disease: Insights into patient profile – Use of inhaled corticosteroids/long-acting β2-Agonists or long-acting β2-agonists/long-acting muscarinic antagonists

Abstract

The noncommunicable chronic obstructive pulmonary disease (COPD) ranks among the top five leading causes of death worldwide. It is a preventable chronic disease that has become a major public health concern globally, as well as in India. To improve the pharmacotherapeutic management of COPD and to increase awareness about the prevalence of the disease, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) has updated recommendations for the disease, based on the current clinical evidence. The present GOLD guideline endorses inhaled corticosteroids (ICS) combined with long-acting β2-agonists (LABA) for a subgroup of patients. The article is an attempt to clearly define patient profiles that stand to benefit from ICS/LABA, LABA/long-acting muscarinic antagonists (LAMA), and ICS/LABA/LAMA combination therapy based on current clinical evidence. The discussion is presented under the following headings: (i) disease burden worldwide, as well as in India; (ii) clinical symptoms and diagnosis of disease; (iii) risk factors leading to the development of disease; (iv) pharmacotherapeutic agents for COPD; (v) current updated recommendations from GOLD guidelines; (vi) subgroup of patients who can benefit from various combinations of therapeutic agents; and (vii) comparative analysis of clinical studies on various GOLD guideline-suggested combination therapies.

Keywords

• bronchodilators
• chronic obstructive lung disease
• eosinophil count
• exacerbations
• inhaled corticosteroids
• long-acting muscarinic antagonists
• long-acting β2-agonists
• smoking