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.
Classification of COPD Severity | |||
GOLD Stages |
Symptoms |
FEV1 (% predicted) |
*FEV1/FVC (%) |
I: Mild |
+/- Symptoms +/- Cough/sputum |
> 80 |
< 70 |
II: Moderate |
+/- Symptoms +/- Cough/sputum/breathing difficulty (dyspnea) |
50 - 80 |
< 70 |
III: Severe |
+/- Symptoms +/- Cough/sputum/dyspnea |
30 - 50 |
< 70 |
IV: Very Severe |
Cough/sputum/dyspnea +/- Respiratory failure +/- Right heart failure |
< 30 Or respiratory failure Or right heart failure |
< 70 |
*Note: FVC -- Forced vital capacity: the maximum volume of air that you can forcibly breathe out from the lungs.FEV1 -- Forced expiratory volume in 1 second: the amount of air you can breathe out during the first second after you take your deepest breath. | |||
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.
Treatment Approach for Stable COPD
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Review Date: 04/10/2010
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine,
Harvard Medical School; Physician, Massachusetts General Hospital.
Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M.,
Inc.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org)
