Management of stable disease

• Note: read the goldcopd guidelines for a detailed explanation of airflow limitation risk, characteristics, and spirometric classifications (Gold 1–4)

• Gold 1—mild disease

   ○ FEV₁/FVC < 70 %

   ○ FEV₁ ≥ 80 % predicted

   ○ Patient A Group: add a short-acting anticholinergic or a short-acting beta₂ agonist prn (e.g., ipratropium or albuterol); alternative can include a long-acting anticholinergic (e.g., tiotropium or aclidinium) or a long-acting beta₂-agonist (e.g., salmeterol or formoterol) or a combination of both a short-acting anticholinergic and a short-acting beta₂ agonist; theophylline may be an option

   ○ Smoking cessation programs, physical activity, flu, and pneumococcal vaccination

• Gold 2—moderate disease

   ○ FEV₁/FVC < 70 %

   ○ FEV₁ < 80 % and ≥50 % predicted

   ○ Patient B Group: add a long-acting anticholinergic or a long-acting beta₂ agonist; alternative can include both a long-acting anticholinergic and a long-acting beta₂ agonist; other possible options can include a short-acting anticholinergic and a short-acting beta₂ agonist or theophylline

   ○ Smoking cessation programs, pulmonary rehabilitation, physical activity, flu, and pneumococcal vaccination

• Gold 3—severe disease

   ○ FEV₁/FVC < 70 %

   ○ FEV₁ < 50 % and ≥30 % predicted

   ○ Patient C Group: add an inhaled corticosteroid (e.g., beclomethasone, budesonide, fluticasone) and a long-acting beta₂ agonist or a long-acting anticholinergic; alternatives can include a long-acting beta₂ agonist and a long-acting anticholinergic or a long-acting anticholinergic and a phosphodiesterase-4 inhibitor (e.g., roflumilast) or a long-acting beta₂ agonist and a phosphodiesterase-4 inhibitor; other possible options can include a short-acting anticholinergic and/or a short-acting beta₂ agonist or theophylline

   ○ Smoking cessation programs, pulmonary rehabilitation, physical activity, flu, and pneumococcal vaccination

• Gold 4—very severe disease

   ○ FEV₁/FVC < 70 %

   ○ FEV₁ < 30 % predicted or presence of chronic respiratory failure or right heart failure

   ○ Patient D Group: add an inhaled corticosteroid and a long-acting beta₂ agonist and/or a long-acting anticholinergic; alternatives can include inhaled corticosteroids and a long-acting beta₂ agonist or a long-acting anticholinergic and/or a phosphodiesterase-4 inhibitor; other possible options can include a short-acting anticholinergic and/or a short-acting beta₂ agonist or theophylline