COPD is a chronic, usually progressive disorder, characterised by airflow obstruction with little reversibility and usually >20 pack years of smoking. Referral for a chest opinion is indicated in those with no or minimal smoking history, or age <40 years. Treatment for COPD is used to decrease symptoms and/or complications. Dyspnoea is the reason most patients seek medical attention and is a major cause of disability and anxiety associated with the disease.
Metered dose inhalers (MDIs) are first-line, however, not all patients can use them. Spacer devices can improve lung deposition with MDIs. Some examples of inhalers which may be used are detailed below, however the drug choice at each step may be determined by the appropriate inhaler device for the patient. Your clinical pharmacist or respiratory nurse specialist can assess the patient and advise on alternative inhaler devices if appropriate.
* Patient has had ≥2 exacerbations in 12 consecutive months.
|FEV1 >50%||FEV1 ≤50%|
|First-line inhaled treatment||SABA||SABA|
|Second-line inhaled treatment||LAMA or LABA||LAMA or LCCI*|
|Third-line inhaled treatment||LAMA + LABA||LAMA + LCCI*|
If this preferred option is not suitable or tolerated, other LABAs and LAMAs are available. See Formulary (www.ggcmedicines.org.uk) or BNF for choices.