STEPWISE MANAGEMENT

OF STABLE COPD
Increasing COPD severity

MILD MODERATE SEVERE

Typical symptoms few symptoms breathless walking on level ground breathless on minimal exertion
breathless on moderate increasing limitation of daily daily activities severely curtailed
exertion activities exacerbations of increasing frequency and
little or no effect on daily recurrent chest infections severity
activities exacerbations requiring oral
cough and sputum corticosteroids and/or antibiotics
production

Typical lung function FEV1 ≈ 60-80% predicted FEV1 ≈ 40-59% predicted FEV1 < 40% predicted

CONFIRM diagnosis. Confirm post-bronchodilator airflow limitation (FEV1 /FVC <0.70) using spirometry. Any pattern of cough with or without
chronic sputum production may indicate COPD.

OPTIMISE function. PREVENT deterioration. DEVELOP a plan of care.

Non-pharmacological REDUCE RISK FACTORS Avoid exposure to risk factors including tobacco smoke and air pollution, support smoking
interventions cessation, recommend annual influenza vaccine and pneumococcal vaccine according to immunisation handbook

OPTIMISE FUNCTION Encourage regular exercise and physical activity, review nutrition, provide education, develop GP
management plan and written COPD action plan (and initiate regular review)

OPTIMISE TREATMENT OF CO-MORBIDITIES especially cardiovascular disease, anxiety, depression, lung cancer and
osteoporosis

REFER symptomatic patients to pulmonary rehabilitation

INITIATE advanced care planning

MANAGE advanced lung disease with

domiciliary oxygen therapy, long-term
non-invasive ventilation, surgery and
bronchoscopic interventions, if indicated

Pharmacological START with short-acting relievers: (used as needed):

interventions SABA (short-acting beta2-agonist) OR SAMA (short-acting muscarinic antagonist)
(inhaled medicines)**

ADD long-acting bronchodilators:

LAMA (long-acting muscarinic antagonist) OR LABA (long-acting beta2-agonist)
Consider need for combination LAMA/LABA depending on symptomatic response

CONSIDER adding ICS (inhaled corticosteroids):

Single inhaler triple therapy (ICS/LABA/LAMA) may be suitable*

*in patients with 1 severe exacerbation requiring hospitalisation or 2 moderate exacerbations in the previous 12 months, AND
significant symptoms despite LAMA/LABA or ICS/LABA therapy; OR in patients stabilised on a combination of LAMA, LABA and ICS.

Assess and optimise inhaler device technique at each visit. Minimise inhaler device polypharmacy

REFER PATIENTS TO LUNG FOUNDATION AUSTRALIA FOR INFORMATION

AND SUPPORT - FREECALL 1800 654 301
Lung Foundation Australia has a range of resources to promote
©Lung Foundation Australia 2023. FL0323V8COPDSTEPWISE

understanding of COPD and assist with management.

Based on The COPD-X Plan: Australian and New Zealand Guidelines for the Management
of COPD and COPD-X Concise Guide
**
Refer to PBS criteria: www.pbs.gov.au

Access a copy of the COPD

inhaler chart, featuring PBS
listed medicines approved
for use in COPD.
1800 654 301 | Lungfoundation.com.au