What is the recommended follow-up treatment for predominant dyspnea in COPD?

The recommended follow-up treatment for predominant dyspnea in COPD is the addition of both a long-acting beta-agonist (LABA) and a long-acting muscarinic antagonist (LAMA). This approach is based on the understanding that managing dyspnea effectively in COPD often requires a combination of therapies that target different pathways to improve airflow and reduce symptoms.

LABAs help to relax the airway muscles, leading to bronchodilation and improved airflow over a longer duration, while LAMAs offer similar benefits through a different mechanism by blocking acetylcholine receptors in the airways. The combination of these two classes of medications often results in better symptom control, including decreased breathlessness and increased exercise tolerance, compared to using either medication class alone.

This combination therapy has been shown in clinical studies to provide better relief of dyspnea and can enhance the quality of life for individuals with COPD. Opting for both a LABA and LAMA is particularly beneficial when patients continue to experience significant dyspnea despite other treatments, as it addresses the multifactorial nature of COPD symptoms.

While inhaled corticosteroids (ICS) and increases in short-acting bronchodilator (SABA) dosages might have certain roles in managing acute exacerb