Figure 2.

Approach to COPD on the basis of the degree of airflow obstruction and peripheral blood eosinophil counts.

Notes: LAMA monotherapy, early in the course of COPD, among patients with FEV₁ of 50% or greater of the predicted FEV₁ will be the first choice rather than LABA monotherapy. If the presence of eosinophilic inflammation in the airways is indicated on the basis of sputum or blood eosinophilia, the initial choice could be an ICS/LABA combination. For patients with frequent exacerbations, whether ICS/LABA should be regularly administered depends on the presence of eosinophilic exacerbation as described in the text. The escalation of bronchodilators and ICSs is recommended in patients with stable COPD who remain breathless or have exacerbations. Ultimately, patients with severe symptoms and/or frequent exacerbations may require “triple therapy” with a LAMA, a LABA, and an ICS.

Abbreviations: COPD, chronic obstructive pulmonary disease; FEV₁, forced expiratory volume in 1 second; ICSs, inhaled corticosteroids; LABA, long-acting β₂-agonist; LAMA, long-acting muscarinic antagonist.