Continuing Education PROGRAM

warranted, it should ideally be provided as a single inhaler or as a LAMA inhaler in combination with an ICS/LABA to prevent patients from inadvertently staying adherent to ICS monotherapy only.1 Cost and coverage must be considered as many insurers require patients to be optimized on a LABA and LAMA before triple therapy will be covered. Pharmacists can continue to support patients with COPD to quit smoking, partake in safe physical activity, keep up to date with influenza, COVID-19 and pneumococcal vaccines, and develop a written COPD action plan to manage acute exacerbations.8

References

1. Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2022 report. Available from: https://goldcopd. org/2022-gold-reports-2/ (accessed October 24, 2022).

2. Koarai A, Yamada M, Ichikawa T, et al. Triple versus LAMA/LABA combination therapy for patients with COPD: a systematic review and meta-analysis. Respir Res 2021;22(1):183. doi:10.1186/s12931-021-01777-x.

3. Calverley PMA, Anderson JA, Celli B, et al. Salmeterol and fluticasone propionate and survival in chronic obstructive pulmonary disease (TORCH). N Engl J Med 2007;356:775-89. doi: 10.1056/ NEJMoa063070.

4. Bourbeau J, Bhutani M, Hernandez P, et al. Canadian Thoracic Society clinical practice guideline on pharmacotherapy in patients with COPD - 2019 update of evidence. Can J Resp Crit Care Sleep Med 2019;3:210-32. doi:10.1080/24745332.2019.1668652.

5. Magnussen H, Disse B, Rodriguez-Roisin R, et al. Withdrawal of inhaled glucocorticoids and exacerbations of COPD. N Engl J Med 2014;371:128594. doi: 10.1056/NEJMoa1407154.

6. Chapman KR, Hurst JR, Frent SM, et al. Longterm triple therapy de-escalation to indacaterol/ glycopyrronium in COPD patients (SUNSET): a randomized, double-blind, triple-dummy clinical trial. Am J Resp Crit Care Med 2018;198:329-39. doi: 10.1164/rccm.201803-0405OC.

7. Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2016 report. Available from: http://goldcopd.org/

8. McIvor RA. Chronic obstructive pulmonary disease. In: Therapeutics [Internet]. Ottawa (ON): Canadian Pharmacists Association; c2016 [updated April 2021]. Available from: http://www.myrxtx.ca