Wixela

@jbud12 , I have been on Advair (Wixela is generic advair) for over 20 years sad to say. I started using wixela when my insurance would no longer cover Advair. I have gone from 500/50 dose to 250/50 dose & tried weaning to 100/50, but I started having more tightness & wheezing. I am now currently on wixela 250/50 & want to wean off, but I started inhaled Arikayce for MAC in March 2025 & got really tight & wheezy, so no more option for weaning I think until I try again maybe after I'm done with Arikayce. I do feel Wixela helps me, however, steroids are known to cause lung damage even if inhaled (per Cleveland Clinic website & National Jewish website & Dr. Lazarro, a top cardiothoracic surgeon for TBM, tracheobronchomalacia, which I also have). So, I still take it because I can breathe so much better. I will still try to wean the dose down again at some point.

Thanks. Thats my concern…. Being on a strroid for long term. I do not want to further damage my lungs. I started using it only once per day instead of twice. I havent noticed a diffrrence…

"Steroids are known to cause lung damage even if inhaled" -- no this is not correct.

Inhaled steroids work by reducing inflammation in the airways, not causing damage. Of course, there are side effects but lung damage is not typically one of them.

Perhaps you're referring to inhaled steroids promoting the growth of NTM. Yes, steroids can encourage the growth of not only NTM but also other organisms such as fungi and Pseudomonas. This is one reason why sputum samples are so valuable.

Steroids are prescribed for those with asthma and sometimes also COPD. It's important to find the minimum effective dose.

I started Wixela 100/50 recently due to contractor applying aeroseal in my home and not taking proper precautions. I was told to use it twice a day but I want to try only once a day. If it gives me relief would that be sufficient in the long run. I am hoping to get off this med in the near future. Any suggestions ?

I am on Wixela 250/50 and I asked my doctor if I could reduce it to the 100/50. He said the lower dose is not formulary for COPD so he would not change my prescription. Has anyone been successful in getting 100/50 prescribed for COPD by their pulmonologist?

@brian93
Two recent drugs have been approved for the treatment of chronic obstructive pulmonary disease (COPD):
1. Ensifentrine (Ohtuvayre)
A nebulized medication that works by inhibiting phosphodiesterases 3 and 4, leading to airway relaxation and reduced inflammation.
Approved by the FDA in June 2024.
2. Dupilumab (Dupixent)
A monoclonal antibody that targets interleukin-4 and interleukin-13, reducing inflammation and mucus production.
Approved by the FDA in September 2024 for patients with eosinophilic COPD.
These drugs provide additional treatment options for COPD patients, particularly those who have not responded well to existing therapies. They may help improve lung function, reduce exacerbations, and improve quality of life.

https://hudson.org.au/news/new-treatment-for-lung-disease-copd-hiding-in-plain-sight/
Researchers have found a promising treatment breakthrough for Chronic Obstructive Pulmonary Disease (COPD) that avoids many drawbacks of current drugs, and it has come from an unexpected place.

COPD is an umbrella term for a number of lung conditions, including emphysema and chronic bronchitis. The disease makes breathing difficult, is often complicated by sudden severe attacks and usually worsens over time.

In Australia it affects around 2 million people and is a significant cause of morbidity and mortality, especially in people over the age of 40 years.

Now studies at Hudson Institute of Medical Research, in conjunction with Monash Health and the Monash Biomedicine Discovery Institute, have found that a drug commonly used to treat lung fibrosis could also be ideal for overcoming key problems associated with current treatments for COPD.

https://www.chestphysician.org/hope-on-the-horizon-for-bronchiectasis/

Great article thanks!!

@brian93
Artesunate shows promise for treating COPD, primarily by reducing inflammation and oxidative stress, and reversing airway remodeling. It works by targeting various cellular pathways, such as the PPAR-\(\gamma \)/TGF-$\beta$1/Smad2/3 signaling pathway, which is crucial in airway remodeling. While these are preclinical and animal study findings, they suggest artesunate could be a novel therapeutic option, particularly for patients whose symptoms are resistant to existing treatments. How artesunate may help with COPD Reduces inflammation and oxidative stress: Artesunate can decrease inflammatory cells and markers, as well as oxidative damage in the lungs, both in animal models and cell cultures exposed to cigarette smoke.Reverses airway remodeling: It has been shown to reverse structural changes in the airways, such as the thickening of the airway wall and smooth muscle proliferation, which are hallmarks of COPD.Targets specific signaling pathways: The drug appears to work by activating the PPAR-\(\gamma \) receptor, which in turn inhibits the TGF-$\beta$1/Smad2/3 pathway, a key driver of airway remodeling.Offers a new therapeutic strategy: Artesunate's ability to target the PI3K/Akt/p70S6K pathway is unique, as it is a mechanism that is not addressed by standard treatments like glucocorticoids, suggesting it could be used in combination therapy for patients who do not respond well to glucocorticoids. Important considerations Primarily research-based: Much of the evidence for artesunate in COPD comes from preclinical and animal studies.Ongoing research: While promising, more research is needed to fully understand its mechanisms and confirm its effectiveness and safety in humans with COPD.