The GOLD (Global Strategy for the Diagnosis, Management, and Prevention of COPD) 2017 report outlines management of a patient with COPD.
Parameters:, other
(1) COPD grade (A, B, C, D)
(2) history of smoking
(3) FEV1 as percent of predicted
(4) chronic bronchitis
|
COPD Grade
|
Initial Therapy
|
Continued Symptoms
|
|
A
|
bronchodilator
|
continue, stop or switch to an alternative class of bronchodilator
|
|
B
|
long-acting bronchodilator (LABA or LAMA)
|
LAMA + LABA
|
|
C
|
LAMA
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(LAMA + LABA) OR (LAMA + ICS)
|
|
D
|
(LAMA) OR (LAMA + LABA) OR (LABA + ICS)
|
(LAMA + LABA + ICS); consider (macrolide if smoker) AND/OR (PDE4 inhibitor)
|
LABA = long-acting beta2 agonist
LAMA = long-acting muscarinic antagonist
ICS = inhaled corticosteroid
PDE4 = phosphodiesterase 4
A macrolide antibiotic may be indicated in a former smoker with frequent exacerbations.
A PDE4 inhibitor (roflumilast, other) may be indicated if FEV1 is less than 50% of predicted (GOLD Stage 3 or 4) and if the patient has chronic bronchitis.
Long-term therapy with oral corticosteroids is not indicated. Long-term monotherapy with ICS is not recommended.
Inhaled bronchodilators are recommended over oral bronchodilators.
Theophylline is not recommended unless other long-term bronchodilators are unavailable or unaffordable.
