Selecting a Treatment Regimen Recommendations
ÎSmoking cessation is the single most effective — and cost effective — intervention in most people to reduce the risk of developing COPD and stop its progression (A).
and 80% predicted with inhaled bronchodilators (Rec: Weak; Evid: Low Qual). ÎTreat stable COPD patients with respiratory symptoms and FEV1
ÎTreat stable COPD patients with respiratory symptoms and FEV1 < 60% predicted with monotherapy, either long-acting inhaled anticholinergics or
inhaled β-agonists (Rec: Strong; Evid: Moderate Qual) or a combination of inhaled therapies (Rec: Weak; Evid: Moderate Qual):
> long-acting inhaled anticholinergics > long-acting inhaled β-agonists > inhaled corticosteroids
ÎAn ICS combined with a long-acting β-agonist is more effective than the individual components in reducing exacerbations and improving lung function and health status (A).
ÎClinicians should prescribe oxygen therapy in patients with COPD and resting hypoxemia (PaO2
(Rec: Strong; Evid: Moderate Qual). ≤ 55 mm Hg or SpO2
ÎClinicians should consider prescribing pulmonary rehabilitation in symptomatic individuals with COPD who have an FEV1 (Rec: Strong; Evid: Moderate Qual).
ÎInfluenza vaccines can reduce serious illness (A).
ÎPneumococcal polysaccharide vaccine is recommended for COPD patients 65 years and older and for COPD patients younger than age 65 with an FEV1
< 40% predicted (B). Adverse Effects
ÎChronic treatment with systemic glucocorticosteroids should be avoided because of an unfavorable benefit/risk ratio (A).
ÎAdverse events from inhalation therapy are minor and similar to those from placebo.
Drug ICS
Anticholinergics β-agonists
Most Common Side Effects
Oropharyngeal candidiasis, easy bruising Dry mouth
Minor cardiovascular events
ÎResults from 2 randomized controlled trials showed that the incidence of fracture during 3 years was similar with ICS and with placebo (1.4% versus 2.0%, respectively).
> However, after 3 years, lumbar spine and femur bone density was lower in the triamcinolone group of the Lung Health Study II.
≤ 88% by pulse oximetry) < 50% predicted between 60%
