Long-Acting Inhaled Drugs for Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) involves progressive airway obstruction and inflammation. COPD inhalation treatments aim to prevent exacerbations, alleviate respiratory symptoms, and improve quality of life. Short-acting bronchodilators address mild COPD, while long-acting bronchodilators (e.g., long-acting beta-agonists [LABAs] and long-acting muscarinic antagonists [LAMAs]) are recommended for moderate to severe COPD. For severe or treatment-resistant COPD, inhaled corticosteroids (ICS) combined with LABA-LAMA may be used.

Canadian guidelines recommend upfront LABA-LAMA therapy for all patients and triple ICS-LABA-LAMA therapy for high-risk patients. However, these guidelines are not aligned with the reimbursement criteria recommended by Canada’s Drug Agency, which require a trial of single and/or dual drugs first. The optimal place in therapy of COPD inhalers is unclear. The proposed Therapeutic Review aims to address uncertainties, including comparative efficacy, safety, and cost-effectiveness analyses, to ensure improved patient outcomes and system sustainability.