- The American Thoracic Society (ATS) issued a clinical practice guideline for pharmacologic management of COPD.
Why this matters
- The guideline is designed to improve QoL and control symptoms while reducing the frequency of exacerbations.
- Expert review based on collaborative effort of COPD clinicians and researchers along with a team of methodologists.
- Recommendations addressing 4 major questions were formulated using GRADE.
- Funding: ATS.
- For patients with COPD complaining of dyspnea or exercise intolerance:
- Use combination treatment with a long-acting β2-agonist (LABA) and long-acting muscarinic antagonist (LAMA) rather than monotherapy with LABA or LAMA.
- If these symptoms persist despite combination therapy, add inhaled corticosteroids to combination therapy (therefore triple therapy) in those with ≥1 exacerbation in the prior year requiring antibiotics or oral steroids or hospitalization.
- Drop the inhaled corticosteroid if no exacerbations occur in the past year.
- Do not use maintenance oral corticosteroid therapy in patients with frequent and severe exacerbations while on optimal therapy.
- Consider opioid-based therapy in patients with advanced refractory dyspnea despite otherwise optimal therapy.
- All but 1 recommendation (the first) were considered conditional rather than strong.