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Chronic medical therapy and the GOLD guidelines 

Chronic medical therapy and the GOLD guidelines
Chronic medical therapy and the GOLD guidelines

Miguel Carrera

, Ernest Sala

, and Alvar GN Agustí

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date: 21 September 2020

Active reduction of risk factors and bronchodilator treatment are central to the management of COPD.

Regular use of long-acting bronchodilators (β‎2-agonists and antimuscarinics) is more effective than short-acting bronchodilators in patients with persistent symptoms.

Inhaled corticosteroids (ICS) combined with bronchodilators are indicated in patients with forced expiratory volume in 1s FEV1 < 50% predicted and repeated exacerbations.

Influenza vaccination is indicated for all COPD patients; while pneumococcal vaccine is recommended for COPD patients older than 65 years, and in those younger with FEV1 < 40% predicted.

Antibiotics should only be used for infectious exacerbations of COPD, while N-acetylcysteine only affects the frequency of exacerbations in patients off inhaled corticosteroids.

Mucolytic agents, antitussives, and vasodilators are not recommended in stable COPD.

All COPD patients benefit from exercise training programmes, while long-term oxygen therapy increases survival in COPD patients with chronic respiratory failure.

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