The minimal clinically relevant difference in trough FEV1 values is considered to be 100 mL values less than this are unlikely to be symptomatically perceived by patients. Trough FEV1 measures the FEV1 immediately prior to the next scheduled dose (eg, when the medication concentration levels would be at their lowest or their trough). However, these advantages are often related to pharmacokinetic properties (eg, reducing the number of daily inhalations required) or the creation of novel combinations of medications such advantages must be considered in the context of the relative efficacy compared to the conventional treatments.Īll of the novel agents and novel combination products utilized trough forced expiratory volume in 1 second (FEV1) as their primary outcome measure in their pre-marketing clinical trials. Each agent and each formulation has potential advantages over conventional treatment options. Multiple agents have been approved for the treatment of COPD ( Table). These new agents and combinations offer potential advantages over the previously available inhaled medications.ĭo these potential advantages make these new agents the preferred first-line agents for the treatment of COPD, to be used in place of the “conventional” inhaled medications? Recently, multiple inhaled medications have received FDA approval for the treatment of COPD. Furthermore, all LABA + ICS combinations were required to be given twice daily while tiotropium was the only available long-acting muscarinic antagonist (LAMA). Previously, the inhaled medications in the armamentarium of COPD treatment were extremely limited and combination therapy (2 agents available in a single product) was limited to long-acting beta-agonists (LABA) and inhaled corticosteroids (ICS). She returned to her primary care practitioner 1 month after her exacerbation for consideration of additional treatment options.Īs CD experienced her second COPD exacerbation within 12 months her risk stratification per the Global Initiative for Chronic Obstructive Lung Disease guidelines has shifted from Category B to Category D, prompting an escalation in her treatment in order to reduce her risk for future exacerbations and improve her symptoms of COPD. Since starting this medication, she is feeling better, but after 8 months of treatment she experienced a COPD exacerbation following a viral upper respiratory tract infection. Last month we reviewed the case of CD, a 63-year-old white female who was diagnosed with chronic obstructive pulmonary disease (COPD) and initiated on tiotropium.
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