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COPD Management

Dr Swapnil Pawar February 14, 2021 948

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    COPD Management
    Dr Swapnil Pawar

Written by  – Dr Andrew Lam

Chronic Obstructive Pulmonary Disease (COPD)

Chest X-Ray Findings of COPD

  • Flattening of the hemidiaphragms
  • Narrowing of the mediastinum
  • Hyperlucency of the lung fields
  • Decreased peripheral broncho-vascular markings
  • Hyperinflation (More more than 6 anterior ribs or 10 posterior ribs visible above the diaphragm in the mid-clavicular line


Gold Classification for Severity of Airflow Limitation

Stage Severity Percentage Predicted FEV1
GOLD 1 Mild >80%
GOLD 2 Moderate 50 – 79%
GOLD 3 Severe 30 – 49%
GOLD 4 Very Severe <30%

FEV1 – Forced expiratory volume in 1 second


Escalation of Long-Term COPD Therapy

Step 1: Long Acting Bronchodilator Monotherapy (i.e. LAMA or LABA)
Long-Acting Muscarinic Antagonists (LAMA’s) – tiotropium, glycopyrronium, aclidinium
Long-Acting Beta2 Agonists (LABA’s) – formoterol, salmeterol, indacaterol

Step 2: LAMA + LABA
e.g. Spiolto (olodaterol + tiotropium), Anoro (vilanterol + umeclidinium)

Step 3 :Inhaled corticosteroid (ICS) + LAMA + LABA
e.g. Trelegy (fluticasone + umeclidinium + vilanterol), Spiriva (tiotropium) + Seretide (Fluticasone + salmeterol)



Weerakkody, Y., Ho, M.L. et al. (2020) Chronic obstructive pulmonary disease. Retrieved January 30, 2021 from

Han, M.K., Dransfield., M.T., Martinez., F.J. (2020). Chronic obstructive pulmonary disease: Definition, clinical manifestations, diagnosis and staging. UpToDate. Retrieved January 30, 2021, from

Electronic Therapeutic Guidelines. (2020) Stable chronic obstructive pulmonary disease (COPD). eTG Complete. Retrieved January 30, 2021, from

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