New COPD Guidelines Issued

By Amy Orciari Herman

Edited by David G. Fairchild, MD, MPH, and Lorenzo Di Francesco, MD, FACP, FHM

The American Thoracic Society has issued guidelines on the pharmacologic management of chronic obstructive pulmonary disease (COPD) in the American Journal of Respiratory and Critical Care Medicine.

The main recommendations:

• For patients with COPD and dyspnea or exercise intolerance, use combination treatment with a long-acting 2-agonist (LABA) and long-acting muscarinic antagonist (LAMA) rather than LABA or LAMA monotherapy. This is the only recommendation rated "strong;" the rest are considered "conditional."

• For patients with dyspnea or exercise intolerance despite taking LABA/LAMA combination therapy, the group suggests adding inhaled corticosteroids in those who've had at least one COPD exacerbation in the prior year that required antibiotics, oral steroids, or hospitalization.

• For those taking triple therapy (LABA/LAMA/inhaled corticosteroid), the group suggests stopping the corticosteroid if there have been no exacerbations in the past year.

• For patients with frequent and severe exacerbations while on optimal therapy, the group advises against maintenance oral corticosteroid therapy.