TABLE 5.
Additional treatments for stable chronic obstructive pulmonary disease (COPD)
| Theophylline | Roflumilast | Macrolide | N-acetylcysteine | Oral carbocisteine | |
| Czech Republic | REC: emphysematous | REC: frequent exacerbators, bronchitic, COPD and bronchiectasis | REC: (option) frequent exacerbators, bronchitic, COPD and bronchiectasis | REC: frequent exacerbators, bronchitic, COPD and bronchiectasis | REC: frequent exacerbators, bronchitic, COPD and bronchiectasis |
| England and Wales | REC: after inhaled treatments | NR | NR | REC | NR |
| Finland | REC: possibly in patients with low exacerbation risk | REC: in high exacerbation risk if frequent exacerbations, chronic bronchitis, and FEV1 <50% pred | REC: for specialist use only | NO: not for long-term use | NO: not for long-term use |
| France | REC: only when treatment goals are not attained with inhaled treatments | Not reimbursed | NR | NO | NO |
| Germany | REC: third choice | Not available | Studies not available | REC: only for viscous secretions | NR |
| Italy | NR | REC: for patients not controlled with bronchodilators, FEV1 <50% pred, ≥2 exacerbations per year and chronic bronchitis | NR | NR | NR |
| Poland | REC: with qualifications | REC: not reimbursed | NO | REC | REC |
| Portugal | REC: only if better options cannot be used | Not available | NR | NR | NR |
| Russia | REC | REC | REC | REC | REC |
| Spain | REC: third-line | REC: second-line | REC: third-line | REC: second-line | REC: second-line |
| Sweden | NO: but may be used | REC | NR | NO | NR |
REC: recommended; NR: no recommendation; FEV1: forced expiratory volume in 1 s; NO: not recommended.