What Works Best to Ease Flare-Ups of COPD?
The best available drugs to treat sudden COPD flare-ups are the medications already widely in use, antibiotics and corticosteroids, a new evidence review has concluded.
There's not enough evidence to recommend newer treatments for chronic obstructive pulmonary disease (COPD), said lead researcher Dr. Claudia Dobler, a visiting scholar at the Mayo Clinic in Rochester, Minn.
Surprisingly, there's not even much research available for so-called rescue inhalers, even though doctors know that the short-acting bronchodilators can help restore breathing during a flare-up, she said.
"We know from practice they do release breathlessness," Dobler said. "But there are two types available, and there's nothing really to guide us about whether one is better than the other, or whether a combination of the two is better than just one alone."
For this study, Dobler's team analyzed results from 68 clinical trials to see if they could suss out which drugs would best help patients who are struggling to draw breath due to a COPD flare-up.
"We found more evidence to confirm previous findings that antibiotics work and so do corticosteroids," Dobler said. "We have collected more support for what is already being done, but really nothing for any new treatments."
Sixteen million Americans have been diagnosed with COPD, the fourth-leading cause of death in the United States, according to the U.S. National Heart, Lung, and Blood Institute (NHLBI). People with COPD find it progressively harder to draw breath.
COPD is caused by long-term exposure to irritants that damage the lungs and airways. Smoking is the main risk factor; as many as three out of four people with COPD either smoke or used to smoke, the NHLBI says.
Antibiotics help COPD patients by eliminating bacterial infections that clog the airways, Dobler said.
"Once a patient gets worse, their lungs are more susceptible to getting infected with bacteria," she said. "From that point of view, it makes a lot of sense to treat these people for infection."
Corticosteroids ease breathing by reducing inflammation that tightens the airways, Dobler said.
These findings make sense, said Dr. Len Horovitz, a pulmonary specialist at Lenox Hill Hospital in New York City.
"This study shows that antibiotics help improve function. This would be true when a specific bacteria is isolated, but also antibiotics can be useful because they may have an anti-inflammatory effect," Horovitz said. "For optimal anti-inflammatory effect, steroids certainly are an option that clearly improves lung function."
Both types of drugs are effective in treating flare-ups even if the situation isn't dire enough to require hospitalization, the researchers found.
Even in patients dealing with a COPD flare-up at home, "these two medications are effective," Dobler said.
The antibiotic findings should come as a relief for doctors who fret about prescribing the drugs because of the global rise in antibiotic-resistant bacteria, Dobler added.
"I think our findings actually tell physicians they don't have to feel guilty about using antibiotics quite generously in these patients," she said.
But the researchers concluded there's scant evidence available for most other treatments, including newer ones. They were particularly stunned to find very little research supporting use of rescue inhalers, even though they're known to work, Dobler said.
"That's quite surprising, because so many people use them," she said. "That's just something that we do."
The evidence review highlights just how little progress has been made in treating COPD, the researchers concluded.
"The progress we make is really only in very small increments," Dobler said. "Overall, at this point in time, it remains a disease where our options are somewhat limited. The most effective measure remains that people stop smoking or never start smoking in the first place."
The new evidence review was published online Feb. 24 in the Annals of Internal Medicine.
The U.S. National Heart, Lung, and Blood Institute has more about COPD.
SOURCES: Claudia Dobler, M.D., Ph.D., visiting research scholar, Mayo Clinic Evidence-Based Practice Center, Rochester, Minn.; Len Horovitz, M.D., pulmonary specialist, Lenox Hill Hospital, New York City; Feb. 24, 2020, Annals of Internal Medicine, online