Escalation of COPD maintenance pharmacotherapy in patients with exacerbations

This algorithm represents our approach to adjustment of pharmacologic therapy in patients receiving treatment for COPD who experience exacerbations. All patients with COPD should have a rapid relief inhaler available, either a SABA or a SABA-SAMA (SABA preferred for patients using a LAMA). For additional information, refer to UpToDate content on the overview of management and follow-up management of stable COPD.

COPD: chronic obstructive pulmonary disease; ICS: inhaled corticosteroids (glucocorticoids); LABA: long-acting beta-agonist; LAMA: long-acting muscarinic antagonist; SABA: short-acting beta-agonist; SAMA: short-acting muscarinic antagonist.

* Ensifentrine may reasonably be substituted for LAMA or LABA therapy if one of these agents cannot be used due to adverse effects or other contraindications.

¶ In patients with exacerbations and blood eosinophil count ≥300 cells/microL, the addition of ICS is likely to be of benefit. Patients with eosinophil counts <100 cells/microL are less likely to experience improvements in exacerbations.

Δ For patients who are on LABA-ICS therapy, switching to LAMA-LABA-ICS rather than LAMA-LABA is a reasonable option if there has been a beneficial effect from the ICS without adverse effects.

Graphic 147638 Version 3.0

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Escalation of COPD maintenance pharmacotherapy in patients with exacerbations