Attention A T users. To access the menus on this page please perform the following steps. 1. Please switch auto forms mode to off. 2. Hit enter to expand a main menu option (Health, Benefits, etc). 3. To enter and activate the submenu links, hit the down arrow. You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links.

HIV/AIDS

Quick Links

Veterans Crisis Line Badge
My healthevet badge

COPD: Treatments according to Stage

for Health Care Providers

Table 1: Treatments according to Stage

Back to COPD Chapter

* There are important interactions between some inhaled corticosteroids and certain ARVs. See Table 3: Potential ARV Interactions.

All Patients:

  • Avoid triggers and exposures
  • Receive annual influenza vaccine
  • Receive pneumococcal vaccine every 5 years
StageSpirometric ClassificationTreatment
I: Mild
  • FEV1/FVC <0.70
  • FEV1≥80% predicted
  • Short-acting bronchodilator as needed: beta-agonists such as albuterol, levalbuterol, and pirbuterol, and/or anticholinergics such as ipratropium
II: Moderate
  • FEV1/FVC <0.70
  • FEV1 50-79% predicted
Short-acting bronchodilator, plus:
  • Long-acting bronchodilator (fixed dosing schedule): beta-agonists (eg, salmeterol, formoterol, arformoterol) and/or anticholinergics (eg, tiotropium)
  • Pulmonary rehabilitation
III: Severe
  • FEV1/FVC <0.70
  • FEV1 30-49% predicted
Each of the above, plus:
  • Inhaled corticosteroid* for repeated exacerbations (steroid in order of increasing potency: triamcinolone, flunisolide, beclomethasone, budesonide, fluticasone)
  • For patients with significant symptoms, consider addition of theophylline: may improve symptom control
IV: Very Severe
  • FEV1/FVC <0.70
  • FEV1<30% predicted
Each of the above, plus:
  • Oxygen supplementation if PaO2<60
  • Consider surgical procedures
Respiratory FailurePaO2<60 mmHg with or without PaCO2>50 mmHgSame as "IV: Very Severe" above

From Chronic Obstructive Pulmonary Disease
Primary Care of Veterans with HIV
Office of Clinical Public Health Programs
Veterans Health Administration, 2009