• Trough is the low point in a variable measurement^1,2
• In COPD, trough FEV₁ is the measurement prior to the next dose

• In COPD, improvement in trough FEV₁ of ≥ 100 mL may lead to clinically meaningful outcomes³
• Morning (a time of trough FEV₁) is usually when COPD symptoms are more noticeable/at their worst^3,4
• 37% of COPD patients reported problems with morning routine as bothersome*⁵

• Patients using SABA^† therapy (≥4 times daily)
  • May have 4 or more troughs a day
• GOLD guidelines recommend long-acting bronchodilators for maintenance therapy⁶

• Inhaled short-acting bronchodilators are recommended as needed for acute symptoms in all stages of COPD

* Quantitative Internet survey of 803 COPD patients, including 289 patients with severe COPD. Questionnaire consisted of 34 questions quantifying the nature, extent, and impact of COPD symptoms at different times of day.

† SABA = short-acting beta2-agonist.

Mean change from baseline in FEV₁ at Week 12 in a 12-week, multicenter, randomized, double-blind, placebo-controlled trial to assess the efficacy and tolerability of nebulized BROVANA 15 mcg vs placebo in patients with COPD. Salmeterol was an active comparator, and there was no statistically significant difference between the BROVANA and salmeterol treatment groups for the primary efficacy endpoint.^7,8

• In an ad hoc analysis of 212 patients, the majority (56%, n=118) of patients had ≥ 100 mL improvement in trough FEV₁ at Week 12*⁹
• Overall efficacy was maintained throughout the 12-week study period. While some tolerance to the bronchodilator effect was observed after 6 weeks of dosing (at the end of the dosing interval), it was not accompanied by other clinical manifestations of tolerance^7,10
• BROVANA improved morning symptom ratings (assessed nighttime symptoms) from baseline^†8,11
• BROVANA increased mean symptom-free nights by 19% from baseline over 12 weeks*^†12
• All patients (including those in placebo group) received rescue albuterol and supplemental ipratropium for use as needed throughout trial, except within 6 hours of PFT visit

FEV₁ = forced expiratory volume in 1 second.

PFT = pulmonary function test.

* Pooled data from 2 identical 12-week, double-blind, placebo-controlled, randomized, multicenter trials (trials A & B) assessing the efficacy and tolerability of nebulized BROVANA 15 mcg twice daily (n=288) vs placebo (n=293) in patients with COPD.

† Patients completed a COPD questionnaire upon rising in the morning to assess nighttime symptoms. Patients reported the number of times they woke during the night due to lung disease symptoms. Symptoms were defined as coughing, wheezing, chest tightness, bringing up mucus, shortness of breath, other.