The Canadian Thoracic Society updated his recommendations for patients with Chronic Obstructive Pulmonary Disease (COPD). It now recommends initiating maintenance treatment with either a long-acting muscarinic antagonist (LAMA) or a long-acting beta2-agonist (LABA) for all patients with chronic obstructive pulmonary disease (COPD). In addition, for patients with stabel COPD and moderate to high symptoms but low exacerbation risk and forced expiratory volume in 1 second less than 80%, it is now recommended to. start dual Long-Acting Beta2 Agonist (LABA) and Long-Acting Muscarinic Agonist (LAMA) bronchodilator therapy as first-line treatment. In addition, those patients with stable COPD and moderate to high symptoms but low exacerbation risk and forced expiratory volume in 1 second less than 80%.
On a similar note, the Canadian Thoracic Society now recommend initiation triple inhaler therapy with combination of LAMA, LABA, and inhaled corticosteroid (ICS) for patient with COPD who have a higher risk of exacerbations and greator symptom burden. For this population, the Canadian Thoracic Society advises against stepping down to dual LAMA-LABA bronchodilation. The Canadian Thoracic Society now discourage LABA-ICS inhaler combinations without a LAMA bronchodilator when an ICS is indicated for COPD management.