COPD

1. Everyone: long-acting anti-muscarinic (LAMA)
   • Spiriva HandiHaler- tiotropium inhalation powder
   • Incruse Ellipta- umeclidinium inhalation powder
   • Lonhala Magnai- glycopyrrolate
   • Tudorza Pressair- aclidinim
   • Yupelri Neb- revefenacin
2. If moderate or severe: combination of ICS/LABA or LAMA/LABA
   • ICS / LABA
     • Advair Diskus- fluticasone and salmeterol
     • Advair HFA- fluticasone and salmeterol
     • AirDuo RespiClick- fluticasone and salmeterol
     • Breo Ellipta- fluticasone and vilanterol
     • Wixela Inhub- - fluticasone and salmeterol
     • Symbicort- budesonide and formoterol
     • Dulera- mometasone and formoterol
   • LAMA / LABA
     • Anoro Ellipta- umeclidinium and vilanterol inhalation powder
     • Stialto Respimat- tiotropium and olodaterol inhalation spray
     • Bevespi Aerosphere- glycopyrrolate and formoterol inhalation aerosol
     • Duaklir Pressair- aclidinium and formoterol
3. If also have allergic symptoms/rhinitis, start a leukotriene inhibitor. Could also start a leukotriene inhibitor for "regular" COPD after a LABA (so, before going to triple therapy)
   • Singulaire- montelukast
   • Zyflo- zileuton ER
4. Last: triple therapy
   • Trelegy Ellipta- fluticasone furoate, umeclidinium, and vilanterol inhalation powder
   • Breztri Aerosphere- budesonide, glycopyrrolate, and formoterol inhaler
   • For triple therapy, JW has Dulera plus Spiriva
5. Then biologics (step 5)
6. Cinquair- reslizumab
7. Dupixent- dupilumab
8. Fasenra- benralizumab
9. Nucala- mepolizumab
10. Tezspire- tezepelumab-ekko
11. Xolair- omalizumab

Note: in asthma, use steroids first, in COPD steroids last.

Other rx's

• Short-acting Muscarinic Agonists (SAMA)
  • Atrovent HFA- Atrovent
  • Atrovent Neb- Atrovent
• Short-acting SAMA/ICS
  • AirSupra- albuterol and budesonide
• Short-acting SABA/SAMA
  • Combivent Respimat- ipratropium and albuterol
  • DuoNeb- ipratropium and albuterol
• Long-acting Beta-2 Agonists (LABA)
  • Brovana Neg- arformoterol
  • Perforomist Neb- formoterol
  • Serevent Diskus- salmeterol
  • Striverdi Respimat- olodaterol
• Inhaled Corticosteroids
  • Alvesco HFA- ciclesonide
  • ArmonAir RespiClick- fluticasone
  • Arnuity Ellipta- fluticasone
  • Asmanex HFA- mometasone
  • Asmanex Twisthaler- mometasone
  • Budesonide inhalation suspection
  • Fluticasone Propionate Diskus
  • Pulmicort Flexhaler- budesonide
  • Pulmicort Respules- budesonide inhalation suspension
  • QVAR Redihaler- beclomethasone
• PDE Inhibitors
  • PDE4
    • Daliresp- roflumilast
  • PDE3/4
    • Ohtuvayre- ensifentrine