Table 3. Recommendations for LAMA/LABA combination therapy in the COPD guidelines in different countries or from different organizations.

Guidelines	Year	Recommendations
GOLD	2021*	Initial treatment: LAMA/LABA combination therapy may be chosen for Group D patients. Follow-up: patients who still have dyspnea or/and exacerbation on bronchiolar monotherapy should use dual therapy
	2017	Group B: for patients with persistent breathlessness on monotherapy, the use of two bronchodilators is recommended. For patients with severe breathlessness, initial therapy with two bronchodilators may be considered. Group C: patients with persistent exacerbations may benefit from LAMA/LABA combination therapy. Group D: Patients should receive LAMA/LABA combination therapy
	2013	Group B: for patients with severe breathlessness, the second choice is LAMA/LABA combination therapy. Group C: dual bronchodilator therapy is an alternative choice. Group D: dual bronchodilator therapy is an alternative choice
GesEPOC	2017	Low-risk: patients who still have symptoms or clear exercise limitations on bronchodilator monotherapy should use dual bronchodilator therapy. High-risk: patients with the nonexacerbated phenotype, exacerbated with emphysema phenotype, and exacerbated with chronic bronchitis phenotype should use LAMA/LABA combination therapy as an initial treatment
	2014	Nonexacerbated phenotype: LAMA/LABA can be used in patients with severity levels of II and III. Exacerbated with emphysema phenotype and exacerbated with chronic bronchitis phenotype: LAMA/LABA is can be selected for patients with severity level II
NICE	2018	LAMA/LABA is recommended for people who: (I) have spirometrically confirmed COPD and; (II) have no asthmatic features/features suggesting steroid responsiveness and; (III) remain breathless or have exacerbations despite having used or been offered treatment for tobacco dependence if they smoke, optimized nonpharmacological management, relevant vaccinations, and a short-acting bronchodilator
ATS	2020	LAMA/LABA combination therapy is recommended over LABA or LAMA monotherapy in COPD patients with dyspnea or exercise intolerance (strong recommendation, moderate certainty of evidence)

*, from the GOLD document 2019, the recommendations for medical treatment are divided into initial treatment and follow-up. GOLD groups of patients are not considered in the medical treatment recommendation during follow-up. LAMA, long-acting muscarinic antagonist; LABA, long-acting β agonist; COPD, chronic obstructive pulmonary disease; GesEPOC, Spanish COPD Guideline; NICE, National Institute for Health and Care Excellence; ATS, American Thoracic Society.