ATS GUIDELINES Bundle

Treatment ➤ In patients with COPD who complain of dyspnea or exercise intolerance, the ATS recommends long-acting β 2 -agonist (LABA)/ long-acting muscarinic antagonist (LAMA) combination therapy over LABA or LAMA monotherapy (strong recommendation, moderate certainty evidence). ➤ In patients with COPD who complain of dyspnea or exercise intolerance despite dual therapy with LABA/LAMA, the ATS suggests the use of triple therapy with inhaled corticosteroids (ICS)/LABA/LAMA over dual therapy with LABA/LAMA in those patients with a history of one or more exacerbations in the past year requiring antibiotics or oral steroids or hospitalization (conditional recommendation, moderate certainty evidence). ➤ In patients with COPD who are receiving triple therapy (ICS/ LABA/LAMA), the ATS suggests that the ICS can be withdrawn if the patient has had no exacerbations in the past year (conditional recommendation, moderate certainty evidence). ➤ The ATS does not make a recommendation for or against ICS as an additive therapy to long-acting bronchodilators in patients with COPD and blood eosinophilia, except for those patients with a history of one or more exacerbations in the past year requiring antibiotics or oral steroids or hospitalization, for whom we suggest ICS as an additive therapy (conditional recommendation, moderate certainty evidence). ➤ In patients with COPD and a history of severe and frequent exacerbations despite otherwise optimal therapy, the ATS advises against the use of maintenance oral corticosteroid therapy (conditional recommendation, low certainty evidence). ➤ In individuals with COPD who experience advanced refractory dyspnea despite otherwise optimal therapy, the ATS suggests that opioid-based therapy be considered for dyspnea management, within a personalized shared decision-making approach (conditional recommendation, very low certainty evidence).

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