COPD Foundation treatment guidelines48

Short-acting bronchodilatorLAMA or LABA or LAMA plus LABAICS/LABARoflumilastOxygenExercise/ pulmonary rehabilitationLung volume reduction surgeryAzithromycina
Spirometry gradeb
SG1 MildFirst line as neededPossibly second line
SG2/3 Moderate/ SevereFirst line as neededFirst lineSecond lineSecond linec
Regular symptomsFirst line as neededFirst lineSecond lineFirst line
Exacerbation risk highFirst linedFirst linedSecond linecSecond line
Severe hypoxemiaFirst line
Episodic hypoxemiaPossibly second line
EmphysemaSecond line in selected cases
Chronic bronchitisSecond linec
ComorbiditiesEvaluate 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,