Pharmacologic Therapies for Preventing COPD Exacerbations: A Comprehensive Review.

Abstract

Chronic obstructive pulmonary disease (COPD) is a progressive respiratory disease marked by acute exacerbations that drive disease progression, hospitalizations, and mortality. Effective management prioritizes preventing these exacerbations due to their detrimental impact on long-term outcomes. This review synthesizes current evidence on pharmacologic interventions to reduce exacerbations, encompassing inhaled therapies, oral treatments, and emerging agents. Established inhaled agents, such as long-acting beta-agonists (LABAs), long-acting muscarinic antagonists (LAMAs), and inhaled corticosteroid (ICS) combinations, play a central role, with personalized selection based on patient factors like blood eosinophil count and exacerbation history. Oral treatments, including roflumilast and azithromycin, provide additional benefit for patients with specific profiles, such as chronic bronchitis or frequent exacerbations. Roflumilast, a PDE-4 inhibitor, has shown efficacy in reducing exacerbations when used alongside inhaled therapies, while azithromycin offers anti-inflammatory and antimicrobial effects, particularly benefiting elderly ex-smokers. Emerging therapies like ensifentrine, a dual PDE-3/4 inhibitor, and dupilumab, targeting type 2 inflammation, show potential for reducing exacerbations in select phenotypes. Collectively, this evidence supports a personalized, phenotype-driven approach to COPD management, optimizing therapeutic strategies to reduce exacerbation frequency and improve patient outcomes.