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COPD Treatment Options: GOLD Guidelines-Based Pharmacotherapy and Non-Drug Strategies

COPD management follows GOLD guidelines, tailored to symptom burden (mMRC/CAT) and exacerbation history.

Pharmacotherapy

  • Bronchodilators: LAMA (tiotropium, umeclidinium), LABA (salmeterol, formoterol, indacaterol, olodaterol). First-line.
  • LAMA/LABA combos: Preferred for symptomatic patients.
  • ICS/LABA: Add if blood eosinophils ≥300/µL or history of asthma/≥2 exacerbations.
  • Triple therapy (ICS/LAMA/LABA): For frequent exacerbators on dual therapy.
  • PDE4 inhibitor (roflumilast): Chronic bronchitis phenotype, FEV₁<50%, exacerbations.
  • Chronic azithromycin: Select exacerbators (monitor hearing/QT).

Non-Pharmacologic

  • Smoking cessation (paramount).
  • Pulmonary rehabilitation (gold standard).
  • Oxygen (if PaO₂ ≤55 mmHg or SpO₂ ≤88%).
  • Vaccines: flu, pneumococcal, COVID, RSV, Tdap.
  • LVRS/transplant (end-stage).

Regular reassessment adjusts therapy to evolving needs.

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