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Slide 5

Patient Care

Optimizing COPD Treatment: Prioritizing LAMA/LABA Therapy for Stable Patients

Now we have clinical evidence-based guideline such as GOLD to provide concise recommendation for optimal maintenance treatment of stable COPD patients, LABA/LAMA is almost my first line therapy with fewer side effects. Additional therapy can be further escalated as clinical and/or biomarker are appropriate. We are entering an era of COPD treatment.

Slide 1

Prescribing Decisions

The importance of treating COPD early

Upon review of the other comments, my practice is very similar. Very few patients in Pulmonary Clinic with mild COPD (selection bias), so not too many on LAMA or LABA in isolation (usually preferring a LAMA). Most on LAMA/LABA to start, with trying to adhere to the usual indications to escalate to triple therapy. To quote Dr. K above, "I reserve my nebulizer treatment for patients who are unable to use inhalers properly either due to their poor respiratory effort or neuromuscular weakness", but will also use nebulized therapies for cost/coverage via Medicare Part B when costs are high for inhalers through Part D.

Slide 3

Patient Care

Optimizing COPD Management: A Shift Toward Long-Acting Therapies

Given the chronicity of COPD adopting a chronic disease management view & counselling the patient about goals of reducing the progression is beneficial IMHO. Avoiding exacerbations would be a primary goal to lessen burden of disease & prevent further impairment. Teasing out unconscious modifications patients have adopted due to their pulmonary limitations I find helps rationalize using maintenance therapy versus reactive use of rescue medications. Once daily preventative medication to improve long term outcomes.

Slide 4

Prescribing Decisions

Optimizing COPD Management: A Shift Toward Long-Acting Therapies

Since COPD is a chronic and progressive disease, it's always important and worthy a while to invest time and effort to review the difference between a maintenance and a rescue inhaler for a new patient. I will do my best to answer any questions my patients may have about the disease and therapy options. LAMA is almost always my first therapeutic option if clinically indicated. It's also important to explain to the patients that there are various options within any maintenance inhalers depending on their insurance coverage.

Slide 2

Patient Care

GOLD guidelines to inform therapeutic decisions for COPD

As a Pulmonologist, by virtue of selection bias based on the overall cohort that gets referred, the harder question is who does NOT benefit from maintenance therapy. As such almost all patients who present are category B or E. Most recently the GOLD guidelines provided better clarity on ICS use, and other options for AECOPD reduction.

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