| Bronchodilators |
| GOLD 2013 |
Bronchodilator medications are given on either an as-needed basis or a regular basis to prevent or reduce symptoms |
| GesEPOC 2012 |
Short-acting bronchodilators (β2 agonists and/or anticholinergic drugs) should be used on demand for immediate relief in patients with COPD as an add-on to basal treatment regardless of disease severity |
| GesEPOC 2012 |
Long-acting bronchodilators should be used as first-line treatment in all patients with chronic symptoms |
| GesEPOC 2012 |
Tiotropium should preferred to salmeterol in patients with stable COPD who require a sustained action bronchodilator as monotherapy and had experienced at least one previous exacerbation requiring hospitalization and/or treatment with systemic corticosteroids and/or antibiotics during the previous year |
| GesEPOC 2012 |
The choice of the bronchodilator in patients with stable COPD who require a sustained action bronchodilator as monotherapy should be based on 1) the patient’s preferences, 2) the individual response to the drug, and 3) pharmacoeconomic considerations |
| GesEPOC 2012 |
Combinations of long-acting bronchodilators should be considered for COPD patients with persistent symptoms despite monotherapy |
| Inhaled steroids combinations |
| GOLD 2013 |
Long-term treatment with inhaled corticosteroids is recommended for patients with severe and very severe COPD and frequent exacerbations not adequately controlled by long-acting bronchodilators |
| GOLD 2013 |
Long-term monotherapy with inhaled corticosteroids is not recommended in COPD because it is less effective than the combination of inhaled corticosteroids with long-acting β2 agonists |
| GesEPOC 2012 |
Inhaled corticosteroids should invariably be used in association with long-acting bronchodilators |
| GesEPOC 2012 |
Combinations of long-acting β2 agonist and inhaled corticosteroids should be used in patients with COPD who present frequent exacerbations despite treatment with long-acting bronchodilators |
| GesEPOC 2012 |
Triple therapy (addition of a long-acting antimuscarinic agent to a long-acting β2 agonist and inhaled corticosteroids) should be used in patients with severe or very severe COPD and poorly controlled symptoms despite treatment with long-acting bronchodilators |
| SEPAR 2009 |
Triple therapy (addition of a long-acting antimuscarinic agent to a long-acting β2 agonist and inhaled corticosteroids) is justified in patients with severe or very severe COPD in presence of symptomatic deterioration despite treatment with long-acting bronchodilators |
| Oral steroids |
| GOLD 2013 |
Long-term monotherapy with oral corticosteroids is not recommended in COPD |
| SEPAR 2009 |
Oral corticosteroids are not recommended for maintenance therapy in stable COPD |
| Antibiotics |
| GOLD 2013 |
The use of antibiotics (other than for treating infectious exacerbations of COPD and other bacterial infections) is not currently indicated |
| GesEPOC 2012 |
The coexistence of COPD with frequent exacerbations and bronchiectasis with chronic bronchial infection should be treated with antibiotics, in line with the recommendations for bronchiectasis |
| Mucolytics |
| GOLD 2013 |
Mucolytics: the widespread use of these agents cannot be recommended at present |
| GOLD 2013 |
There is some evidence that treatment with mucolytics (such as carbocysteine and N-acetyl-cysteine) may reduce exacerbations in COPD patients not receiving inhaled corticosteroids |
| GesEPOC 2012 |
Carbocysteine is suggested as a maintenance treatment in patients with stable COPD, an exacerbator phenotype, and chronic bronchitis |
| Other treatments |
| GOLD 2013 |
The phosphodiesterase-4 inhibitor, roflumilast, may also be used to reduce exacerbations in patients with chronic bronchitis, severe and very severe COPD, and frequent exacerbations not adequately controlled by long-acting bronchodilators |
| GOLD 2013 |
Young patients with severe hereditary alpha-1 antitrypsin deficiency and established emphysema may be candidates for alpha-1 antitrypsin augmentation therapy |
| GOLD 2013 |
Nedocromil and leukotriene modifiers have not been adequately tested in COPD patients and cannot be recommended |
| Methylxanthines |
| SEPAR 2009 |
Theophyllines should be used whenever a patient remains symptomatic despite appropriate treatment according to disease stage, or in the few cases in which an oral route is required |
| GesEPOC 2012 |
Theophylline should not be used as first-line treatment because of its potential adverse effects |
| GOLD Treatment strategies |
| GOLD 2013 |
Group A. A short-acting bronchodilator is recommended as first choice for all Group A patients |
| GOLD 2013 |
Group A. A combination of short-acting bronchodilators or the introduction of a long-acting bronchodilator represents the second choice |
| GOLD 2013 |
Group B. Long-acting bronchodilators are superior to short-acting bronchodilators (taken as needed or as necessary) and are therefore recommended |
| GOLD 2013 |
Group B. The second choice for patients with severe breathlessness is a combination of long-acting bronchodilators |
| GOLD 2013 |
Group C. A fixed combination of inhaled corticosteroid/long-acting beta2-agonist or a long-acting anticholinergic drug is recommended as first choice |
| GOLD 2013 |
Group C. A combination of two long-acting bronchodilators or the combination of inhaled corticosteroid/long-acting anticholinergic can be use as second choice |
| GOLD 2013 |
Group D: The first choice consists of an inhaled corticosteroid plus a long-acting β2 agonist or a long-acting anticholinergic drug, with some evidence for triple therapy |
| GOLD 2013 |
Group D. A combination of all three classes of drugs (inhaled corticosteroids/long-acting β2 agonist/long-acting anticholinergic drugs) can be used as second choice although conflicting data exist |
| GesEPOC Treatment strategies |
| GesEPOC 2012 |
The drugs to be added to long-acting bronchodilators depend on the clinical phenotype. The treatment of the non-exacerbator phenotype in emphysema or chronic bronchitis is based on the use of combined long-acting bronchodilators |
| GesEPOC 2012 |
The treatment of patients with an overlapping phenotype is based on the use of long-acting bronchodilators combined with inhaled corticosteroids |
| GesEPOC 2012 |
The treatment of the frequent exacerbator phenotype with emphysema is based on long-acting bronchodilators, with the potential addition of inhaled corticosteroids and theophylline according to the severity level |
| GesEPOC 2012 |
The treatment of the chronic bronchitis frequent exacerbator phenotype is based on long-acting bronchodilators, with the potential addition of inhaled corticosteroids, phosphodiesterase 4 inhibitors or mucolytics according to the severity level. In selected cases, the preventive use of antibiotics can be considered |
