COPD Management | About COPD

COPD Is a Challenging and Variable Chronic Disease1

What makes COPD so complex?

Nature of the disease

  • Chronic and progressive2
  • Interaction of internal and external factors on the lungs1
  • High variability between patients1

Patient population

  • Interplay of environmental and genetic risk factors2
  • Health beliefs, perceptions, history, and habits3
  • Nonadherence (intentional or unintentional)4
  • Response, preference, and ability to use an inhalation device2,4


  • Patients are often co- (or multi-) morbid2
    • Influence of comorbid conditions on COPD and the effect of COPD on them


The management of COPD adds an additional layer of complexity

Among COPD patients:

>2/3 in clinical practice make at least 1 error using an inhalation device2

As many as 47% of patients on a particular device made critical errors in one real-world assessment of device mishandling5*

About 50% are estimated to be adherent6

*Critical errors are those that affect delivery of medication to the lungs. 212 general practitioners and 50 pulmonologists assessed handling of 3393 devices used for continuous treatment of COPD in 2935 patients. Devices assessed included Breezhaler® (n=876), Diskus® (n=452), HandiHaler® (n=598), a pMDI (n=422), RESPIMAT® (n=625), and Turbuhaler® (n=420). Weaknesses of the study include physician self-selection and a low physician participation rate. Additionally, inhalation parameters were not able to be measured.5

Device match

  • Individual patient response, preference, and abilities should guide device selection2
  • Despite GOLD recommendations, >2/3 of COPD patients make at least 1 error using an inhalation device2
What patient factors might be considered for device matching?
  • Ability to create sufficient inspiratory flow2
  • Coordinating device actuation with inhalation7
  • Understanding when to inhale and exhale, and with what amount of force2,8
  • Possessing the cognitive and/or physical capacity to administer a medication8
  • Preference and/or ability to operate the device2
  • Preference and/or ability to set up and clean a device8
  • Comfort with the taste and feel of inhaled medications8,9

Device misuse

Misuse and/or underuse may contribute to:

  • Suboptimal symptom control over time2
  • Exacerbations5

LONHALA® MAGNAIR® (glycopyrrolate) Inhalation Solution has not been shown or indicated to impact exacerbations in prospective, randomized, placebo-controlled trials.

Assessment and adjustment

  • Per GOLD, treatment should be assessed at every visit, with modifications as needed2
  • Changing a COPD drug and/or device can produce many treatment possibilities4

If you and your patients are experiencing the frustrations of device mismatch and/or misuse, consider another treatment option

If you and your patients are experiencing the frustrations of device mismatch and/or misuse, consider another treatment option


GOLD does not endorse any specific treatments
COPD=chronic obstructive pulmonary disease; GOLD=Global Initiative for Chronic Obstructive Lung Disease.


1. Houben-Wilke S, Augustin IM, Vercoulen JH, et al. COPD stands for complex obstructive pulmonary disease. Eur Respir Rev. 2018;27(148):1-12. doi: 10.1183/16000617.0027-2018.
2. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: 2019 report. Global Initiative for Chronic Obstructive Lung Disease (GOLD). 2019:1-139.
3. Restrepo RD, Alvarez MT, Wittnebel LD, et al. Medication adherence issues in patients treated for COPD. Int J Chron Obstruct Pulmon Dis. 2008;3(3):371-384.
4. Braido F, Lavorini F, Blasi F, Baiardini I, Canonica GW. Switching treatments in COPD: implications for costs and treatment adherence. Int J Chron Obstruct Pulmon Dis. 2015;10:2601-2608.
5. Molimard M, Raherison C, Lignot S, et al. Chronic obstructive pulmonary disease exacerbation and inhaler device handling: real-life assessment of 2935 patients. Eur Respir J. 2017;49(2):1-7. doi: 10.1183/13993003.01794-2016.
6. Bourbeau J, Bartlett SJ. Patient adherence in COPD. Thorax. 2008;63(9):831-838.
7. Ibrahim M, Verma R, Garcia-Contreras L. Inhalation drug delivery devices: technology update. Med Devices (Auckl). 2015;8:131-139.
8. Dhand R, Dolovich M, Chipps B, Myers TR, Restrepo R, Farrar JR. The role of nebulized therapy in the management of COPD: evidence and recommendations. COPD. 2012;9(1):58-72.
9. Cuvelier A, Muir JF, Benhamou D. Dry powder ipratropium bromide is as safe and effective as metered-dose inhaler formulation: a cumulative dose response study in chronic obstructive pulmonary disease patients. Respir Care. 2002;47(2):159-166. 

Important Safety Information & Indication

Important Safety Information

LONHALA MAGNAIR is contraindicated in patients with a hypersensitivity to glycopyrrolate or to any of the ingredients.

LONHALA MAGNAIR should not be initiated in patients with acutely deteriorating or potentially life-threatening episodes of COPD or used as rescue therapy for acute episodes of bronchospasm. Acute symptoms should be treated with an inhaled short-acting beta2-agonist.

As with other inhaled medicines, LONHALA MAGNAIR can produce paradoxical bronchospasm that may be life-threatening. If paradoxical bronchospasm occurs following dosing with LONHALA MAGNAIR, it should be treated immediately with an inhaled, short-acting bronchodilator; LONHALA MAGNAIR should be discontinued immediately and alternative therapy instituted.

Immediate hypersensitivity reactions have been reported with LONHALA MAGNAIR. If signs occur, discontinue LONHALA MAGNAIR immediately and institute alternative therapy.

LONHALA MAGNAIR should be used with caution in patients with narrow-angle glaucoma and in patients with urinary retention. Prescribers and patients should be alert for signs and symptoms of acute narrow-angle glaucoma (e.g., eye pain or discomfort, blurred vision, visual halos or colored images in association with red eyes from conjunctival congestion and corneal edema) and of urinary retention (e.g., difficulty passing urine, painful urination), especially in patients with prostatic hyperplasia or bladder-neck obstruction. Patients should be instructed to consult a physician immediately should any of these signs or symptoms develop.

The most common adverse events reported in ≥2% of patients taking LONHALA MAGNAIR, and occurring more frequently than in patients taking placebo, were dyspnea (4.9% vs 3.0%) and urinary tract infection (2.1% vs 1.4%).

LONHALA solution is for oral inhalation only and should not be injected or swallowed. LONHALA vials should only be administered with MAGNAIR.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit or call 1-800-FDA-1088.

For additional information, please see full Prescribing Information and Patient Information for LONHALA MAGNAIR at


LONHALA® MAGNAIR® (glycopyrrolate) is an anticholinergic indicated for the long-term maintenance treatment of airflow obstruction in patients with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and/or emphysema.