21st March 2024

Respiratory system

For those with uncontrolled mild to moderate COPD who are on salbutamol, there should be an assessment of the following asthmatic features, previous secure diagnosis of asthma or atopy, a higher eosinophil count, substantial variation in FEV1 and/or substantial variation in peak expiratory flow (at least 20%). If features are present a long acting beta agonist (LABA) and inhaled corticosteroids (ICS) should be given. If no features are present, a LABA and LAMA can be given.

The stop criteria highlights considering cessation of anti-muscarinic bronchodilators (ipratropium and tiotropium) in those with a history of narrow angle glaucoma as it may exacerbate glaucoma and in those with bladder outflow obstruction as it may lead to urinary retention.

Inhaled corticosteroids are preferred to systemic corticosteroids for the maintenance of COPD due to the unnecessary exposure to long term systemic side effects. Theophylline with its narrow therapeutic index should not be used as monotherapy for asthma or COPD as there are safer and more effective alternatives.