Chronic Obstructive Lung Disease Medications

Treatment

The appropriate medications for COPD depend on its stage of severity, which is determined by the symptoms. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) has proposed a strategy that is widely accepted. GOLD categorizes COPD severity as follows:

• Stage I: Smoker's cough, little or no shortness of breath, no symptoms of COPD, FEV1 greater than 80% of predicted.
• Stage II: Shortness of breath on exertion, sputum-producing cough, some symptoms of COPD, FEV1 50 - 80% of predicted.
• Stage III: Shortness of breath on mild exertion, FEV1 30 - 50% of predicted.
• Stage IV: Shortness of breath on mild exertion, right heart failure, bluish skin, nails, and lips (cyanosis), FEV1 less than 30% of predicted.

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The American College of Physicians has issued revised guidelines for COPD treatment, which include:

• In patients with stable COPD, reserve treatment for those who have respiratory symptoms and FEV1 of less than 60% of predicted.
• Patients with symptoms and FEV1 of less than 60% of predicted should be treated with long-acting inhaled beta-agonists, long-acting inhaled anticholinergics, or inhaled corticosteroids. Combination inhaled therapies may be used in these patients.
• Patients with COPD and resting hypoxia should be treated with oxygen therapy.
• Patients with symptoms and FEV1 of less than 50% of predicted should consider pulmonary rehabilitation.