Synopsis
Build a benefit-led stable COPD plan using smoking treatment, rehabilitation, device-matched bronchodilation, selective corticosteroid/advanced therapy and formal oxygen assessment.
- Treat tobacco dependence, physical deconditioning, vaccination needs, nutrition and comorbidity alongside inhalers; medication alone is not comprehensive COPD care.
- Use a short-acting bronchodilator when needed initially. If breathlessness or exacerbations persist without asthmatic/steroid-responsive features, offer LABA+LAMA.
- If asthmatic features suggest steroid responsiveness, consider LABA+ICS; review pneumonia and systemic ICS risk and never use ICS monotherapy for COPD.
Key red flags
Stable SpO2 at or below 92%, cyanosis, polycythaemia, pulmonary hypertension, peripheral oedema or very severe obstruction should prompt formal ABG-based LTOT assessment, not an oxygen prescription from oximetry alone.
Investigation priorities
Choose treatment target and measure benefit.
Management branches
Persistent breathlessness or exacerbations after short-acting therapy and non-pharmacological care.
- Check diagnosis, smoking treatment, technique/adherence and offer pulmonary rehabilitation. Keep SABA or SAMA as-needed initially; stop regular SAMA when a LAMA begins.
- Without asthmatic/steroid-responsive features, offer LABA+LAMA. With such features, consider LABA+ICS, explaining ICS benefits and pneumonia risk.
Stable SpO2 ≤92%, very severe obstruction, cyanosis, polycythaemia, oedema or pulmonary hypertension.
Key medicines
Tiotropium/olodaterol LABA+LAMA (example)5 micrograms tiotropium plus 5 micrograms olodaterol inhaled once daily as 2 puffs of Respimat 2.5/2.5 micrograms.
Beclometasone/formoterol/glycopyrronium triple inhaler (example)Trimbow 87/5/9 micrograms: 2 inhalations twice daily; maximum 2 inhalations twice daily.