Management of Chronic Obstructive Pulmonary Disease (COPD)

Pharmacological Management

The American College of Physicians recommends inhaled bronchodilators for symptomatic patients with FEV1 between 60% and 80% predicted 1
The American College of Physicians strongly recommends inhaled bronchodilators for symptomatic patients with FEV1 <60% predicted 1
Long-acting inhaled anticholinergics or long-acting inhaled β-agonists are recommended as monotherapy for symptomatic patients with FEV1 <60% predicted by the American College of Physicians 1
Combination inhaled therapies may be considered for symptomatic patients with FEV1 <60% predicted by the American College of Physicians 1
Pulmonary rehabilitation is strongly recommended for symptomatic patients with FEV1 <50% predicted by the American College of Physicians 1

Smoking cessation is essential at all stages of COPD, as recommended by the British Thoracic Society 2
Exercise should be encouraged within the limitations of airways obstruction, according to the British Thoracic Society 3
Nutritional support should be considered, especially for malnourished patients with severe COPD, as suggested by the British Thoracic Society 3
Influenza vaccination is recommended, especially for moderate to severe disease, by the British Thoracic Society 2

Beta-blocking agents (including eyedrop formulations) should be avoided as they can worsen bronchospasm, according to the British Thoracic Society 4
Medications without proven benefit, such as antihistamines or mucolytics, should not be used, as recommended by the British Thoracic Society 5