Figure 2.

Standard COPD medication treatment for both groups according to GOLD 2019 and Vietnam Ministry of Health Guideline. Matched patients with COPD will be treated using the same treatment based on their GOPD 2019 classification (groups A, B, C and D). Group A (not included in this study): a single bronchodilator will be used and based on the clinical assessments and persistence of the symptoms to continue/stop or replace by another bronchodilator. Group B: single LAMA or LABA will be initially used. If the symptoms are not reduced, a combination of both LAMA and LABA will be applied. Group C: a single LAMA drug will be used for initial treatment. If exacerbations occur, LAMA and LABA combination will be applied as priority. The LAMA+ICS will be applied in specific cases based on clinical assessment, as the ICS has been reported to have severe side effects on lung inflammation. Group D: Should start the treatment with LAMA. If the patient has CAT >20, LABA and LAMA will be used as initial treatment. LABA+ICS will be used as the initial treatment only when the patient has asthma COPD overlap or the patient’s eosinophil level >300. If exacerbation occurs after the initial treatment, the combination of LAMA, LABA, and ICS should be applied. Additional roflumilast should be used if FEV₁ <50% and the patient has chronic bronchitis. Macrolide should be used if the patient is a former smoker. The red arrow indicates priority treatment. COPD, chronic obstructive pulmonary disease; GOLD, Global Initiative for Chronic Obstructive Lung Disease; ICS, inhaled corticosteroid; LABA, long-acting β agonists; LAMA, long-acting muscarinic antagonists; m-MRC, modified medical research council.