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COPD: Treatments according to Stage

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Table 1: Treatments according to Stage

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* 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