If the patient has exacerbations, consider triple therapy with a long-acting muscarinic antagonist (LAMA), a LABA, and an inhaled corticosteroid (ICS).Ī typical fluticasone furoate dose is 100 mcg via oral inhalation once daily. At follow-up, if the patient is still experiencing dyspnea, consider switching inhaler device and investigate for other causes of dyspnea. An ICS combined with a LABA is more effective than the individual components in improving lung function and health status and reducing exacerbations in patients with exacerbations and moderate to very severe COPD however clinical trials failed to demonstrate a statistically significant effect on survival. Combination of a LABA with an ICS has the greatest likelihood of reducing exacerbations in patients with blood eosinophil counts of 200 cells/microL or more. According to the Global Initiative for Chronic Lung Disease (GOLD) guidelines, ICS may be used in combination with an inhaled long-acting beta-2 agonist (LABA) as initial therapy in group D (those with a high risk of exacerbation). Do not use for the relief of acute bronchospasm use a short-acting beta-2 agonist (SABA). The optimal dose for COPD is not established, although inhaled corticosteroids (ICS) are well-accepted treatments for patients at risk for exacerbation per COPD guidelines. Typical doses range from 100 to 250 mcg via oral inhalation twice daily.
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