Short-acting bronchodilator | LAMA or LABA or LAMA plus LABA | ICS/LABA | Roflumilast | Oxygen | Exercise/ pulmonary rehabilitation | Lung volume reduction surgery | Azithromycina | |
---|---|---|---|---|---|---|---|---|
Spirometry gradeb | ||||||||
SG1 Mild | First line as needed | Possibly second line | ||||||
SG2/3 Moderate/ Severe | First line as needed | First line | Second line | Second linec | ||||
Regular symptoms | First line as needed | First line | Second line | First line | ||||
Exacerbation risk high | First lined | First lined | Second linec | Second line | ||||
Oxygenation | ||||||||
Severe hypoxemia | First line | |||||||
Episodic hypoxemia | Possibly second line | |||||||
Emphysema | Second line in selected cases | |||||||
Chronic bronchitis | Second linec | |||||||
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.