Chronic Obstructive Pulmonary Disease Treatments

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Risk Factors: genetic factors, exposure to particles (tobacco smoke, occupational dusts, outdoor air pollution), oxidative stress, respiratory infections, nutrition, comorbidities.

• Stage 1: Mild—FEV1/FVC<0.70; FEV1≥80% predicted.
• Stage 2: Moderate—FEV1/FVC<0.70; 50%≤FEV1<80% predicted.
• Stage 3: Severe—FEV1/FVC<0.70; 30%≤FEV1<50% predicted.
• Stage 4: Very Severe—FEV1/FVC<0.70; FEV1<30% predicted or FEV1<50% predicted + CRF.

Step-wise treatment: Visit the Global Initiative for Chronic Obstructive Lung Disease (GOLD) website at for information about use of medications at various stages of COPD.

Generic Brand Form Usual Dosage
Long-Acting Beta2‑Agonists (LABAs)
arformoterol Brovana1 soln Adults: Inhale 15mcg twice daily (AM & PM) by
nebulization (max: 30mcg/day). Use standard jet
nebulizer with air compressor (see literature).
Children: Not recommended.
formoterol Perforomist1,2 soln Adults: One 20mcg vial twice daily (AM & PM) by
oral inhalation via nebulizer (max: 40mcg/day)
Children: Not recommended.
indacaterol Arcapta Neohaler1,2 caps Adults: 1 inh of one 75mcg caps once daily, using
Neohaler device. Do not swallow caps.
Children: Not recommended.
olodaterol Striverdi Respimat MDI Adults: 2 inh daily; max 2 inh/day.
Children: Not established.
salmeterol Serevent Diskus2 DPI Adults: 1 inh (50mcg) twice daily (AM & PM)
every 12hrs
Children: Not recommended.
Short-Acting Anticholinergics
ipratropium bromide 1 soln Adults: 500mcg by oral nebulization 3−4 times
daily every 6−8hrs
Children: Not recommended.
Atrovent HFA1 MDI Adults: 2 inh 4 times daily (max: inh/day)
Children: Not recommended.
Long-Acting Anticholinergics
aclidinium bromide Tudorza Pressair DPI Adults: 1 inh (400mcg) twice daily.
Children: Not established.
glycopyrrolate Seebri Neohaler caps Adults: 1 oral inh of one 15.6mcg caps twice daily (AM & PM). Do not swallow caps.
Children: Not established.
tiotropium bromide Spiriva HandiHaler1 caps Adults: 2 oral inhalations of one 18mcg caps once
daily, using HandiHaler device. Do not swallow caps.
Children: Not recommended.
umeclidinium Incruse Ellipta DPI Adults: 1 inhalation once daily.
Children: Not established.
Anticholinergic + Beta2‑Agonist
ipratropium bromide + albuterol 1 soln ≥18yrs: 1 vial (3mL) 4−6 times daily via nebulizer
<18yrs: Not recommended
MDI Adults: 1 inh 4 times daily (max: 6 inh/day)
Children: Not recommended.
Anticholinergic + Long-Acting Beta2‑Agonist (LABA)
glycopyrrolate + formoterol Bevespi Aerosphere1,2 MDI Adults: 2 inh twice daily (in the AM + PM); max 2 inh twice daily.
Children: Not established.
glycopyrrolate + indacaterol Utibron Neohaler caps Adults: 1 oral inh of one 27.5mcg/15.6mcg caps twice daily (AM & PM), using Neohaler device. Do not swallow caps.
Children: Not established.
tiotropium + olodaterol Stiolto Respimat MDI Adults: 2 inh once daily (max: 2 inh/day)
Children: Not established.
umeclidinium + vilanterol Anoro Ellipta DPI Adults: 1 inh once daily
Children: Not established.
Corticosteroid + Long-Acting Beta2-Agonist (LABA)
budesonide + formoterol Symbicort 160/4.52 MDI Adults: 2 inh of 160/4.5mcg twice daily
Children: Not indicated.
fluticasone + salmeterol Advair 250/50 Diskus2,3 DPI Adults: 1 inh of 250/50mcg twice daily
Children: Not recommended.
fluticasone + vilanterol Breo Ellipta DPI Adults: 1 inh of 100/25mcg once daily (max)
Children: ≤17yrs: Not established.
roflumilast Daliresp1,2 tabs Adults: One 500mcg tab once daily.
Children: Not recommended.

Key: CRF = chronic respiratory failure;  DPI = dry powder inhaler;  FEV1 = forced expiratory volume in one second;  FVC = forced vital capacity;  MDI = metered dose inhaler

1Indicated only for COPD.
2Not indicated for the relief of acute bronchospasm.
3Only Advair 250/50 Diskus twice daily is approved for maintenance treatment of COPD because an efficacy advantage of the higher strength Advair 500/50 over Advair 250/50 has not been demonstrated. Other strengths and formulations of Advair are available.

Not an inclusive list of medications and/or official indications. Please see drug monograph at and/or contact company for full drug labeling.

(Rev. 3/2017)

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