Discontinuing Anticholinergic Duplication in COPD Treatment

Rationale for Discontinuation

The American College of Chest Physicians recommends long-acting muscarinic antagonists, such as revefenacin, over short-acting muscarinic antagonists, like ipratropium, to prevent acute moderate to severe exacerbations of COPD, with a Grade 1A recommendation 1

Patients requiring Duoneb more than twice daily for symptom control are candidates for maintenance LAMA therapy with Yupelri, according to guidelines from Chest 2, 3

The American College of Chest Physicians suggests using a mouthpiece rather than a face mask with nebulized Yupelri to minimize ocular exposure in patients at risk for glaucoma, although this specific recommendation is from Praxis Medical Insights 1
In patients with inadequate symptom control on Yupelri plus rescue albuterol, consider adding a long-acting beta-2 agonist rather than restarting scheduled short-acting bronchodilators, as recommended by Chest 2, 3
Triple therapy, including a LAMA, LABA, and inhaled corticosteroid, is appropriate for patients with very severe COPD and frequent exacerbations, according to Chest 2, 3