Fixed-Dose Combination Products and Inhaled Steroid Use in COPD

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The MD Magazine Peer Exchange “Expanding Treatment Options: The Latest Developments in COPD Therapy” features a panel of physician experts discussing key topics in COPD therapy, including risk factors, personalized treatment, preventive measures, new combination therapies, and more.

This Peer Exchange is moderated by Peter Salgo, MD, professor of medicine and anesthesiology at Columbia University and an associate director of surgical intensive care at the New York-Presbyterian Hospital in New York City.

The panelists are:

• Byron Thomashow, MD, professor of medicine at Columbia University Medical Center, medical director at the Jo-Ann LeBuhn Center for Chest Disease at New York-Presbyterian Hospital, and chairman of the board of the COPD Foundation
• Neil R. MacIntyre, MD, clinical chief of the Pulmonary/Critical Care Division, medical director of Respiratory Care Services, and professor of medicine at Duke University School of Medicine
• Barry J. Make, MD, director of Pulmonary and Respiratory Care for National Jewish Health and professor of medicine at the University of Colorado School of Medicine
• Nicola A. Hanania, MD, MS, associate professor of medicine and director of the Asthma and COPD Clinical Research Center at Baylor College of Medicine

As of the time of the filming, one fixed-dose combination product was available in the United States, combining a LABA and a LAMA in one inhaler. Several others could become available in the near future if they are approved. Data have shown that combining the two agents has produced better outcomes than the single agents, Make said, in terms of exacerbations, lung function, and patient-centered outcomes.

An interesting prescribing pattern in primary care is related to how physicians treat asthma. If a patient has poorly controlled asthma, MacIntyre said, physicians tend to prescribe a combination LABA/inhaled corticosteroid. And he said that, because these same physicians treat COPD as well, that this has evolved to be a main COPD treatment strategy, but we may need to reassess the automatic use of the inhaled steroid for COPD.

Where anti-inflammatory agents are concerned, Thomashow said that he thinks we need better options for COPD than steroids. One way to get physicians to re-evaluate their use of inhaled steroids is to stress their potential risks.