This document discusses the pharmacological treatment of COPD, classifying medications by class. It describes long-acting bronchodilators including LAMAs which block acetylcholine-mediated bronchoconstriction and LABAs which directly relax airway smooth muscle. It also discusses fixed-dose combination LABA/LAMA inhalers, ICS/LABA inhalers, and the PDE-4 inhibitor Roflumilast which reduces inflammation but has no direct bronchodilator effect.

3. 3www.slideshare.net/ashraf eladawy

4. 4

5. 5
Manage Stable COPD

6. 6

7. 7
Pharmacological treatment of COPD
(Lots of inhalers, lots of names…)

8. 8

9. 9
More useful to classify in terms of
classes

10. 10

11. Children’s Healthcare of Atlanta

12. 12

13. 13

14. 14

15. 15

16. 16

17. 17

18. 18

19. 19

20. 20

21. 21

22. 22

23. 23

24. 24

25. 25

26. 26

27. 27

28. 28

29. 29

30. 30
Long-Acting Bronchodilators
• LAMAs
• Block acetylcholine-
mediated
bronchoconstriction (via
M3 receptors)
– Tiotropium
– Aclidinium
– Glycopyrronium
(glycopyrrolate)
– Umeclidinium
• LABAs
• Direct relaxant activity on
airway smooth muscle
(via β2 adrenoceptors)
– Formoterol
– Salmeterol
– Indacaterol
– Oldaterol
– Vilanterol

31. 31

32. 32
LABA
DPI Diskus Serevent®
(salmeterol)
DPI Aerolizer Foradil®
(formoterol)
DPI Breezhaler Onbrez®
(indacaterol)
SMI Respimat Striverdi®
(Olodaterol)

33. 33
Serevent®
(salmeterol)

34. 34

35. 35

36. 36

37. 37

38. 38

39. 39

40. 40

41. 41

42. 42
LAMA
DPI HandiHaler/
SMI Respimat
Spiriva®
(tiotropium)
DPI Breezhaler Seebri®
(glycopyrronium)
DPI Genuair Eklira®
(aclidinium)
DPI Ellipta Incruse®
(umeclidinium)
LAMA inhalers for COPD

43. 43

44. 44

45. 45

46. 46

47. 47

48. 48

49. 49

50. Children’s Healthcare of Atlanta
Proskocil BJ et al. Proc Am Thorac Soc. 2005;2(4):305-310.
SMC relaxationSMC contraction
M3- muscarinic
receptors
Beta Agonists
(LABA)Antocholinergics
(LAMA)
β2-adrenergic
receptors
Mechanisms of action of bronchodilators
on airway smooth muscle

51. 51

52. 52
Fixed-dose
combination
LABA/LAMA
DPI Ellipta Anoro®
(vilanterol/umeclidinium)
DPI Breezhaler Ultibro®
(indacaterol/glycopyrronium)
SMI Respimat Inspiolto®
(olodaterol/tiotropium)
DPI Genuair Duaklir®
(formoterol/aclidinium)
Combination LABA/LAMA inhalers for COPD

53. 53

54. 54

55. 55

56. 56

57. 57

58. 58

59. 59

60. 60

61. 61

62. 62
ICS/LABA
DPI Diskus Advair®
(Fluticasone/salmeterol)
DPI Turbuhaler Symbicort®
(Budesonide/formoterol)
DPI Ellipta Relvar®
(Fluticasone/vilanterol)

63. 63

64. 64
Diskus

65. 65

66. 66

67. 67

68. 68

69. 69

70. 70

71. 71

72. 72

73. 73

74. 74

75. 75

76. 76

77. 77
Phosphodiesterase-4 inhibitor: Roflumilast (Daliresp)
i. Indication:
As a daily treatment to reduce the risk of COPD exacerbations in
patients with severe COPD (FEV1 less than 50% of predicted)
associated with chronic bronchitis and a history of frequent
exacerbations.
ii. Mechanism: Reduces inflammation through inhibition of the
breakdown of intracellular cyclic adenosine monophosphate;
no direct bronchodilator activity page

78. 78

79. 79

80. 80
iii. Dose: 500 mcg orally once daily
iv. Contraindications:
Moderate to severe liver impairment; use in nursing mothers
v. Precautions:
Weight loss (monitor); psychiatric events including suicidality
(monitor; weigh risk/benefit ratio in patients with preexisting
psychiatric illness).
Twenty percent of patients studied had weight loss of 5%–10% of
body weight, compared with 7% with placebo; average
weight loss was 2 kg.

81. 81

82. 82

83. 83
vi. Adverse reactions:
Diarrhea, weight loss or decreased appetite, nausea, headache,
back pain, influenza, insomnia, and dizziness
vii. Drug interactions:
Use with strong cytochrome P450 (CYP) enzyme inducers is
not recommended (e.g., rifampin, phenobarbital,
carbamazepine, phenytoin); use with CYP3A4 inhibitors
or dual inhibitors of CYP3A4 and CYP1A2 (e.g., erythromycin,
ketoconazole, fluvoxamine)
increases roflumilast exposure and adverse effects (risk/benefit
ratio must be weighed).

84. 84

85. 85

86. Children’s Healthcare of Atlanta
86

87. 87