Sep 16, 2019

COPD – Which is better: LABA/LAMA or LABA/ICS?

Keith Varnes

On September 10, 2019, I attended an educational event sponsored by Scott Schumaker, Health System Business Manager, Boehringer Ingelheim, in Grapevine, Texas. As you are probably aware, Boehringer Ingelheim is the company that produces the Respimat inhaler. I was intrigued by this learning opportunity because I feel that while respiratory therapists need to be good at hundreds of things, we need to be really, really, really, good at managing two diseases: COPD and asthma. In fact, I always tell respiratory students to become experts in three things: COPD, asthma, and ABGs. 

Pharmacological treatments for COPD are basically: oxygen (yes, it’s a drug), bronchodilators, steroids, antibiotics, PDE4 inhibitors, antioxidants, and mucolytics. Choosing which to use can be tricky.

The takeaways from the meeting I want to share are these:

  1. The best predictor for exacerbation risk was a previous exacerbation.
  2. The more exacerbations a patient has, the more they will have in the future, and the more frequent they will become. This explains the cycles of the “frequent flyers” I see.
  3. Dual bronchodilator therapy (LABA/LAMA) was shown to be superior to bronchodilator/inhaled corticosteroid therapy (LABA/ICS) for preventing exacerbations in patients with previous exacerbations. For more information on this, click here to see the FLAME Study Summary.
  4. ICS therapy has many side effects, including an increased risk of pneumonia. If a patient gets pneumonia, it will be harder to treat. 
  5. Better effect for ICS therapy was found with patients with increased eosinophils (>300). Little or no effect was found with eosinophil rates <100.
  6. When choosing a delivery device, MDI vs DPI, you should consider if the patient can generate a strong enough inhalation. 
  7. Always assess inhaler technique. It is probably better for you to give the inhaler to the patient to use rather than actuating it yourself for the patient. This way you can observe their technique. 
  8. Before escalating therapy, you must ensure that the patient is taking the current therapy correctly.

I have just scratched the surface of COPD management, and there is lots more to know. I encourage all of you to become experts in COPD management, including treatment options for pulmonary rehabilitation. You never know when your expertise in COPD may change the life of your patient for the better.

To learn more about this topic, check out the links below:

Take our Pulmonary Rehab courses for CEU credit (and use code GOLD for 15% off!):

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Keith Varnes

Keith Varnes, RRT-NPS, RRT-ACCS, AE-C, is the company founder, President, and chief visionary of Respiratory Associates. He creates content for our Live and Real-Time Live Broadcast continuing education courses. He has been in the respiratory field since 1983 enjoying a diverse career including DME, software development, agency staffing, and working at a level 1 trauma center. He is also an ACLS and PALS instructor.

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