Chronic Obstructive Pulmonary Disease

Medication

	Class
SAMA	Short Acting Anticholinergics/Muscarinic Antagnists
LAMA	Long Acting Anticholinergics/Muscarinic Antagnists
SABA	Short Acting Beta₂-Antagonists
LABA	Long Acting Beta₂-Antagonists
ICS	Inhaled Corticosteroids
SCS	Systemic Corticosteroids
PDE4-Inhibitor	Phosphodiesterase-4-Inhibitors
–	Methylxanthine

SAMA/SABA — ↑ FEV1 and Symptoms
Combination SAMA + SABA is better than Monotherapy
LAMA/LABA — ↑ Lung Function, Dyspnea + ↓ Exacerbation Rates
Combination LAMA + LABA is better than Monotherapy
Tioproprium — ↑ Pulmonary Rehabilitation by ↑ Exercise Capacity
Combination ICS + LABA is better than Monotherapy in ↑ Lung Function, Health Status + ↓ Exacerbation in Moderate and Severe COPD
Long Term ICS Use — ↑ Risk of Pneumonia
Triple Therapy ICS + LABA + LAMA is better than Dual Therapy
PDE4-Inhibitors — ↑ Lung Function + ↓ in Moderate and Severe Exacerbation in patients with Chronic Bronchitis as well as Severe COPD

Class	Medication	Type	Dose	Duration
SAMA	Ipratropiumbromid	MDI	20 µg	6 – 8 Hours
LAMA	Aclinidium	DPI	322 µg	12 Hours
– ·· –	Glycopyrronium	DPI	44 µg	24 Hours
– ·· –	Tioproprium	DPI SMI	18 µg 2.5 µg	24 Hours
– ·· –	Umeclidinium	DPI	55 µg	24 Hours
SABA	Fenoterolhydrobromid	MDI	100 µg	4 – 6 Hours
– ·· –	Salbutamol	DPI MDI	90 – 200 µg 90 – 180 µg	4 – 6 Hours
– ·· –	Terbutalinsulfat	DPI	500 µg	4 – 6 Hours
LABA	Formoterolfumarat-Dihydrat	MDI	10 µg 5.1 – 10.2 µg	12 Hours
– ·· –	Indacaterol	DPI	120 – 240 µg	24 Hours
– ·· –	Olodaterolhydrochlorid	SMI	2.5 µg	24 Hours
– ·· –	Salmeterol	MDI DPI	21 µg 50 µg	12 Hours
SAMA + SABA Combination	Ipratropiumbromid + Fenoterolhydrobromid	MDI SMI	20/50 µg 20/50 µg	6 – 8 Hours
LAMA + LABA Combination	Aclidium + Formoterolfumaratdihydrat	DPI	340/11.8 µg	12 Hours
– ·· –	Indacaterol + Glycopyrronium	DPI	85/43 µg	24 Hours
– ·· –	Umeclidium + Vilanterol	DPI	55/22 µg	24 Hours
– ·· –	Tiotropium + Olodaterol	SMI	2.5/2.5 µg	24 Hours
ICS	Beclometasondipropionat	MDI	100 – 250 µg	–
– ·· –	Budesonid	MDI DPI	184 µg 200 – 400 µg	–
– ·· –	Fluticasonpropionat	MDI DPI	220 µg 250 – 500 µg	–
LABA + ICS Combination	Beclometasondipropionat + Formoterolfumaratdihydrat	MDI	84.6/5 µg	12 Hours
– ·· –	Budesonid + Formoterolhemifumarat	DPI	160 – 320/4.5 – 9 µg	12 – 24 Hours
– ·· –	Salmeterol + Fluticasonpropionat	DPI	47 – 92/231 – 460 µg	–
– ·· –	Fluticasonfuroat + Vilanterol	DPI	92 – 184/ 22 µg	24 Hours

Class	Medication	Dose	Duration
SAMA	Ipratropiumbromid	0.125 – 0.25 mg/mL	6 – 8 Hours
SABA	Salbutamol	0.5 mg/mL	4 – 6 Hours
SAMA + SABA Combination	Ipratropiumbromid + Fenoterolhydrobromid	0.25/0.5 mg/mL	6 – 8 Hours
ICS	Beclometasondipropionat	400 mg/mL	–
– ·· –	Budesonid	500 – 1000 mg/mL	–

Class	Medication	Dose	Duration
SABA	Terbutalinsulfat	7.5 mg	4 – 6 Hours
SCS	Prednisolon	1 – 50 mg	–
– ·· –	Methylprednisolon	4 – 32 mg	–
Methylxanthine	Aminophyllin	200 – 600 mg	up to 24 Hours
– ·· –	Theophyllin	125 – 500 mg	up to 24 Hours

Class	Medication	Dose	Duration
SABA	Reproterolhydrochlorid	0.09 mg/mL	–
– ·· –	Terbutalinsulfat	0.5 mg/mL	4 – 6 Hours
Methylxanthine	Theophyllin	10 mL has 200 mg	up to 24 Hours

Symptoms	Therapy
GOLD Group A	No Therapy OR SABA + SAMA OR LABA/LAMA
GOLD Group B	LABA/LAMA OR LABA + LAMA
GOLD Group C/D Not Previously Treated	LAMA OR LAMA + LABA
GOLD Group C/D Previously Treated	LAMA + LABA
Escalation/Change	LABA + ICS OR LAMA + LABA + ICS
Severe chronic Bronchitis Type	± Roflumilast