Footnotes

• * Consider if highly symptomatic (eg, CAT >20).¹
• ‡ The decision to use LAMA/LABA as initial treatment should be guided by the level of symptoms as an advantage of LAMA/LABA over LAMA for exacerbation prevention has not been consistently demonstrated.¹
• § Consider LABA/ICS if eosinophils ≥300 cells/μL or in patients with a history of asthma.¹
• † such as pneumonia, diabetes, candidiasis, dysphonia, cataracts and osteoporosis^8,9
• # GOLD Group B: For patients with severe breathlessness initial therapy with two bronchodilators may be considered.¹

References

1. Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease; updated 2020. Available at: https://goldcopd.org/wp-content/uploads/2019/11/GOLD-2020-REPORT-ver1.0wms.pdf
2. Ghosh S et al. Int J Chron Obstruct Pulmon Dis. 2019;14:585-595.
3. Loh CH et al. Ann Am Thorac Soc. 2017;14(8): 1305-1311.
4. Müllerová H et al. PLoS One. 2014;9(1):e85540.
5. Anderson P et al. Int J Chron Obstruct Pulmon Dis. 2006;1(3):251-259.
6. Zierenberg B. J Aerosol Med. 1999; 12(suppl 1):S19-S24.
7. American Thoracic Society. Pharmacologic Management of Chronic Obstructive Pulmonary Disease. An Official American Thoracic Society Clinical Practice Guideline. https://www.atsjournals.org/doi/pdf/10.1164/ rccm.202003-0625ST.
8. Suissa S et al. Chest. 2019;155(6):1158-1165.
9. Miravitlles M et al. Respiratory Research 2017;18:198.
10. Suissa S et al. Eur Respir J. 2018;52(6):1801848.
11. Ciciliani AM et al. Int J Chron Obstruct Pulmon Dis. 2017;12:1565-1577