Treatment Options for Stable Chronic Obstructive Pulmonary Disease: Current Recommendations and Unmet Needs

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FIGURE 1
2017 updates to the GOLD ABCD assessment tool³
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FIGURE 2
Current pharmacologic treatment algorithms by GOLD grades A–D³
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FIGURE 3
COPD Foundation Pocket Consultant Guide

TABLE 1

COPD Foundation treatment guidelines⁴⁸

	Short-acting bronchodilator	LAMA or LABA or LAMA plus LABA	ICS/LABA	Roflumilast	Oxygen	Exercise/ pulmonary rehabilitation	Lung volume reduction surgery	Azithromycin^{^a}
Spirometry grade^{^b}
SG1 Mild	First line as needed	Possibly second line
SG2/3 Moderate/ Severe	First line as needed	First line	Second line	Second line^{^c}
Regular symptoms	First line as needed	First line	Second line			First line
Exacerbation risk high		First line^{^d}	First line^{^d}	Second line^{^c}				Second line
Oxygenation
Severe hypoxemia					First line
Episodic hypoxemia					Possibly second line
Emphysema							Second line in selected cases
Chronic bronchitis				Second line^{^c}
Comorbidities	Evaluate and treat identified comorbid conditions as part of first-line therapy

Abbreviations: ICS, inhaled corticosteroid; LABA, long-acting β₂-agonist; LAMA, long-acting muscarinic receptor antagonist; SG, spirometric grade.
↵a Off-label use.
↵b "SG1 Mild" obstruction: post bronchodilator FEV₁/FVC ratio <0.7, FEV₁ ≥60% predicted; "SG2 Moderate" obstruction: post bronchodilator FEV₁/FVC ratio <0.7, 30%≤ FEV₁ ≤60% predicted; "SG3 Severe" obstruction: post bronchodilator FEV₁/FVC ratio <0.7, FEV₁ <30% predicted.
↵c Indicated if chronic bronchitis, high exacerbation risk, and spirometry grades 2/3 are all present.
↵d LAMA, ICS/LABA, LAMA plus LABA, or LAMA plus ICS/LABA are all potential options depending on frequency of exacerbations and severity of COPD.
Introducing the COPD Foundation Guide for Diagnosis and Management of COPD, recommendations of the COPD Foundation. Rennard S, Thomashow B, Crapo J, et al. COPD: Journal of Chronic Obstructive Pulmonary Disease. 2013;10(3):378–389, reprinted by permission of the publisher Taylor & Francis Ltd, http://www.tandfonline.com.