Respiratory synctial virus (RSV) is a common respiratory virus throughout the world that can cause flare-ups (exacerbations) of COPD. In an out-patient study performed in London and the Netherlands, 8.7% of flare-ups were due to RSV infectioin. Vaccines to prevent flare-ups are available and have been shown to be safe and effective.

On September 27, 2024, the U. S. Food and Drug Administration (FDA) approved the first biologic medicine - dupilumab (brand name: Dupixent) - for the maintenance treatment of patients with COPD. The indication is for those with uncontrolled COPD and elevated eosinophils in the blood. Studies show a 30 to 34% reduction in COPD flare-ups over one year and an improvement in breathing tests. Dupilumab is injected under the skin every two weeks.

On June 26, 2024, the U. S. Food and Drug Administration approved a novel inhaled medication called ensifentrine (Ohtuvayre is the brand name) for the maintenance treatment of patients with COPD. This unique medication has both bronchodilator (opens airways) and anti-inflammatory properties and is delivered in a nebulizer twice a day.

In those adults living in the community with undiagnosed asthma or COPD, those who received pulmonologist directed treatment had less subsequent health care utilization for a respiratory illness than those who received usual care.

In addition, quality of life and lung function had greater improvements with specialty care compared with primary care.

RSV is an abbreviation for Respiratory Syncthial Virus - a common respiratory virus that usually causes mild, cold-like symptoms. Most people recover in a week or two, but RSV can be serious. Infants and older adults are more likely to develop a severe chest infection. In those with COPD it can lead to a flare-up (exacerbation) that might require hospitalization. There are two vaccines that are more than 80% effective in preventing RSV infection.

Your health care professional should prescribe the right medications for your COPD in the right type of inhaler. Your unique abilities should be considered – such as your cognitive function (are you able to understand and follow instructions on how to use?), hand dexterity (can you handle the device correctly?), and peak inspiratory flow (do you have enough ability to breathe in “hard and fast” with a dry powder inhaler?). Shared decision-making is a communication process in which you and your health care professional work together to arrive at the best treatment decisions.

Many, if not most, individuals with COPD have experienced a flare-up or worsening of shortness of breath and/or a productive cough. The medical word for a flare-up is an exacerbation. Generally, the causes of a flare-up include a respiratory infection, either viral or bacterial, and environmental - such as inhaling pollutants in the air. Other possible causes include heart disease, inflammation in the lungs, and psychologic factors - such as anxiety or a panic attack. Appropriate treatment requires the correct diagnosis.

HIIT means High Intensity Interval Training. HIIT exercise in COPD is an alternative approach to training than the lower intensity, longer duration exertion used in many pulmonary rehabilitation programs. It is a popular type of a cardio work-out - could be walking on a treadmill, cycling on a stationary bike, using a stair climbing machine, rowing, jumping rope, etc. HIIT is an intense level of exertion for a short time period. One example involves a 2:1 ratio of walking fast on the treadmill for 30–40 seconds followed by 15–20 seconds of easy or slow walking to recover.

Current recommendations are for the health care professional to select an inhaler based on "access, cost, prescriber, and most importantly, patient’s ability and preference.” For various reasons, inhaler choice is typically a decision by the health care professional. Unfortunately, studies show that individuals with COPD have frequent errors using whatever inhaler device has been prescribed. Another approach to inhaler device selection is "shared decision-making" which enables patients to participate in the process of deciding on which inhaler device "is best for me."

To reduce the chances of another flare-up: do not smoke and avoid inhaling airborne irritants; be up to date on vaccines; do regular exercise; use an inhaled medication approved by FDA that reduces the chances of flare-ups. Furthermore, four medical conditions should be considered: 1) Aspiration - when food, saliva, liquids, or vomit slips into the lungs; 2) Bronchiectasis - a chronic lung condition in which the walls of the large airways (breathing tubes) become damaged and widened; 3) Common Variable Immune Deficiency - a deficiency of Immunoglobulin G makes someone more susceptible to a bacterial infection; and 4) Vitamin D deficiency.

Indoor particulate matter (air pollution) is associated with worse COPD outcomes. In a research study, former smokers with moderate to severe COPD received either active or sham (pretend) high-efficiency particulate air cleaners for 6 months. Those who had an air filter experienced a greater reduction in respiratory symptoms, lower albuterol rescue use, and a lower rate of moderate but not severe flare-ups (exacerbations) compared with the sham group. Possible concerns of using an air cleaner include a higher electricity cost and possible noise when used in the bedroom if you are a "light" sleeper.

Vitamin D boosts the body's immune system and reduces inflammation. The major natural source of Vitamin D is the skin that is dependent on exposure to ultraviolet rays from the sun. Only a few foods, such as fatty fish (salmon and tuna) contain significant amounts of vitamin D. In an analysis of 42 different studies, taking vitamin D reduced the risk of acute respiratory infections by 9% compared with placebo. Daily doses ranged from 400 to 1,000 international units (IU). There were no reported serious side effects associated with Vitamin D supplementation.Add excerpt here

"Triple therapy" refers to three different inhaled medications - a long-acting beta-agonist (LABA), a long-acting muscarinic antagonist (LAMA), and an inhaled corticosteroid (ICS). The two FDA approved “triple therapy inhalers" are Breztri and Trelegy. “Dual therapy” is two bronchodilators – a combination of a LABA and LAMA. In an analysis of 11 studies, there was no difference in shortness of breath scores or risk of hospitalization between triple therapy versus dual bronchodilator therapy in those with COPD. However, in individuals with a history of one or more flare-ups in the past year, the benefits of triple therapy for reducing future flare-ups outweigh the increased risk of pneumonia.

Shortness of breath is the main symptom of COPD that typically limits physical activities and can be disabling. Relief of shortness of breath is one the key goals or treating COPD. In June 2018, the FDA approved the Zephyr Endobronchial Valve System. It is an implantable bronchial valve used to reduce over inflation of the lungs due to severe emphysema. The device consists of a one-way silicone duckbill valve that only allows air to exit from trapped areas. In the LIBERATE study, those with severe hyperinflated emphysema who received placement of Zephyr valves experienced improvements in breathlessness, activity, and psychosocial aspects for one year compared with standard of care.

In November 2018, the FDA approved Primatene Mist for the treatment of mild intermittent asthma. As it is the only over-the-counter inhaler approved by the FDA, some individuals with COPD may consider using it. The active ingredient is epinephrine which plays an important role in the fight-or-flight response; it stimulates the heart to beat faster and harder. Misuse and overuse of Primatene have been well documented and has been associated with people dying. Also, patients may self-medicate with Primatene Mist, thereby delaying effective care. I advise against use of Primatene Mist because of safety concerns. Albuterol is a safer alternative, but requires a prescription.