CHESTGuidelines & Topic CollectionsInitial Maintenance Therapy Selection for Patients With COPD

Initial Maintenance Therapy Selection for Patients With COPD

Assessment of symptoms and history of exacerbations is imperative to guide initiation of therapy in patients with COPD.

Review other infographics in this series:
Escalating Therapy in Patients With COPD Who Remain Symptomatic »
Escalating Therapy in Patients With COPD Experiencing Exacerbations »

Author: Debbie Levine, MD, MS, FCCP

Last updated October 17, 2023

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Global Initiative for Chronic Obstructive Lung Disease risk groups classified by symptoms and exacerbation history

  • Group A: Less symptomatic, low risk of future exacerbations
    • COPD assessment test (CAT) score <10 
    • Moderate exacerbation (no hospitalizations) 
  • Group B: More symptomatic, low risk of future exacerbations 
    • CAT score ≥10 
    • Moderate exacerbation (no hospitalizations) 
  • Group E: High risk of future exacerbations regardless of symptom burden 
    • ≥2 moderate exacerbations or ≥1 leading to hospitalization 

Pharmacologic management should always be used with nonpharmacologic management

  • Avoid risk factors  
  • Smoking cessation 
  • Vaccinations 
  • Pulmonary rehabilitation 
  • Oxygen therapy if meets criteria

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Initial pharmacologic treatment

The foundation of therapy for stable symptomatic COPD is inhaled bronchodilators (long-acting beta agonists [LABA] and long-acting muscarinic antagonists [LAMA]).

Group A: Short- or long-acting bronchodilator (LAMA or LABA)

  • Short-acting bronchodilators (SABD) alone may be appropriate for those with very occasional breathlessness.

Group B: Combination long-acting bronchodilator (LAMA + LABA)

  • Rescue SABD should be used in all patients for immediate symptom relief.

Group E: Combination LAMA + LABA or combination inhaled corticosteroid + LAMA + LABA if blood eosinophils (≥300 cells/µL)

  • Rescue SABD should be used in all patients for immediate symptom relief.

Source: Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease, 2023. www.goldcopd.org

This is a nonpromotional, non-CME disease state educational program brought to you by CHEST in collaboration with and sponsored by GSK.