Medical Treatment Algorithm for Chronic Obstructive Pulmonary Disease
Initial medical treatment of chronic obstructive pulmonary disease (COPD) is guided by severity of obstruction, symptom burden, and exacerbation risk with escalation in therapy targeted to control persistent symptoms or further exacerbations. Exacerbation severity is differentiated by the location of treatment, with moderate exacerbations treated in the outpatient setting with oral corticosteroids, antibiotics, or both and severe exacerbations requiring hospitalization or emergency department care. Additional therapies such as azithromycin and roflumilast can be considered for select patients who continue to experience exacerbations despite optimal inhaled therapy. Further therapies such as azithromycin and roflumilast can be considered in select patients with persistent exacerbations despite maximal inhaled therapy. BMI indicates body mass index, calculated as weight in kilograms divided by height in meters squared; CAT, COPD assessment test; FEV1, forced expiratory volume in the first second of expiration; ICS, inhaled corticosteroid; LABA, long-acting β2-agonist; LAMA, long-acting muscarinic antagonist; SABA, short-acting β2-agonist; SAMA, short-acting muscarinic antagonist.
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