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Chronic obstructive pulmonary disease - Management
What inhaled treatments should I offer a person with COPD whose FEV1 is 50% predicted or greater?

  • If the person is breathless and has exercise limitation:
  • If the person prescribed a SABA or SAMA remains breathless or has exacerbations, offer either of the following:
  • A SABA (as required) may be continued at all stages.
  • If a person taking a LABA remains breathless or has exacerbations:
    • Consider changing to a LABA plus an inhaled corticosteroid (ICS) in a combination inhaler. If an ICS is declined or not tolerated, consider a LAMA plus a LABA.
      • An ICS should not be used as monotherapy in COPD.
  • If a person taking a LABA plus an ICS remains breathless or has exacerbations:
    • Add a LAMA.
  • If a person taking a LAMA remains breathless or has exacerbations:
    • Consider adding a LABA plus an ICS (in a combination inhaler).
  • For an algorithm on the use of inhaled treatments, see the NICE quick reference guide.
  • Consider using a mucolytic or theophylline (methylxanthine).

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