Figure adapted from the recommendations of the Global Initiative for Chronic Obstructive Lung Disease1 (www.goldcopd.org, accessed Jan 2017). LABA, long-acting beta-2-agonist; LAMA, long-acting anti-muscarinic; ICS, inhaled corticosteroid.
*First choice therapy includes short-acting beta2-agonists or short-acting anticholinergic medications as needed for all categories. First choice therapy also includes the first entry followed by a clinical evaluation. If the patient still has symptoms, then moving to the second entry is advised.
**FEV1 impairment is FEV1≥50% predicted for GOLD Categories A and B, and FEV1<50% predicted for Categories C and D.
†Symptoms based on the modified Medical Research Council (mMRC) scale: 0-shortness of breath (SOB) with strenuous exertion, 1-SOB with hurrying on level ground or inclines, 2-SOB with normal walking on level ground >100m, 3-SOB within 100m, and 4-SOB with daily activities; mMRC <2 = low symptoms and mMRC ≥2 = high symptoms.