The Evidence Behind Combination Therapies for 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.

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

that using two long-acting bronchodilators at once leads to better outcomes than single-agent therapy, said Make. An individualized discussion with the patient about this option is warranted though, as some patients do not want to take too much medication, and some may be concerned about cost.

If a patient needs to take two bronchodilators, it may be a good idea to combine them in one device to simplify the regimen for the patient, said Hanania, as long as the combination is not much more expensive, keeping in mind that two separate medications will come with two copays. MacIntyre added that one device means one breathing maneuver, so it might be easier for the patient. And, since adherence is such a problem, simplifying the regimen could be a way to increase adherence, he said.

, said Hanania, there is some speculation that there may be some interaction between beta-2 agonists and anticholinergics at the airway level that could confer benefit from the combination.