Richtlijn 'Medicamenteuze behandeling van COPD'

- The practice guideline ‘Medical treatment of COPD’ completes the practice guideline for diagnostics and non-medicinal treatment.

- Patients with stable chronic obstructive pulmonary disease (COPD) and minor complaints can be treated with short-acting beta-2-adrenoceptor agonists or anticholinergics or a combination of these.

- In cases of insufficient clinical control of the condition or if patients use their medication for maintenance, a long-acting bronchodilator is the drug of choice. In patients with severe or very severe COPD (stage III-IV of the criteria of the Global Initiative for Obstructive Lung Disease (GOLD) or with cardiac comorbidity, there is a slight preference for the long-acting anticholinergic tiotropium.

- Inhaled corticosteroids (ICS) reduce the exacerbation frequency in patients with moderate to severe or very severe COPD (GOLD stage II-IV) and recurrent exacerbations.

- A combination of ICS with long-acting beta-2-adrenoceptor agonists (LABA) is prescribed in patients with GOLD stage III-IV with at least 2 exacerbations in the past year, a deterioration of the quality of life and with symptoms, if treatment with a LABA alone or an ICS alone results in insufficient improvement.

- Anticholinergics and beta-2-adrenoceptor agonists have a similar effect on bronchodilation in patients with an acute exacerbation of COPD.

- If improvement is inadequate, patients with an exacerbation should be treated with prednisolone 30 mg for a period of 7 to 14 days.

- In outpatients and clinical patients with an exacerbation of COPD, an antibiotic is added to prednisolone in very poor lung function (forced expiratory volume in 1 second (FEV₁) < 30) or another risk factor of a severe disease course, such as a respiratory rate ≥ 30/min, a systolic blood pressure < 90 mmHg, and disorientation in time, place or person.

Ned Tijdschr Geneeskd. 2008;152:1465-8