Linda Nici, Manoj J. Mammen, Edward Charbek et al
Am J Respir Crit Care Med Vol 201, Iss 9, pp e56–e69, May 1, 2020
This guideline form the ATS Provides clinical recommendations for the pharmacologic treatment of chronic obstructive pulmonary disease (COPD) summarised as:
- A strong recommendation for the use of long-acting b2-agonist (LABA)/long-acting muscarinic antagonist (LAMA) combination therapy over LABA or LAMA monotherapy in patients with COPD and dyspnoea or exercise intolerance
- A conditional recommendation for the use of triple therapy with inhaled corticosteroids (ICS/LABA/LAMA) over dual therapy (LABA/LAMA) in patients with COPD and dyspnoea or exercise intolerance who have experienced one or more exacerbations in the past year
- A conditional recommendation for ICS withdrawal for patients with COPD receiving triple therapy (ICS/LABA/LAMA) if the patient has had no exacerbations in the past year
- No recommendation for or against ICS as an additive therapy to longacting bronchodilators in patients with COPD and blood eosinophilia, except for those patients with a history of one or more exacerbations in the past year requiring antibiotics or oral steroids or hospitalization, for whom ICS is conditionally recommended as an additive therapy
- A conditional recommendation against the use of maintenance oral corticosteroids in patients with COPD and a history of severe and frequent exacerbations
- A conditional recommendation for opioid-based therapy in patients with COPD who experience advanced refractory dyspnoea despite otherwise optimal therapy.