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The COPD prescribing tools

These tools present pharmacological treatment options for patients with COPD based on their symptoms and exacerbation severity; the first tool is used for treatment initiation and the second tool is used for the escalation or de-escalation of treatment.

Previously, bpacnz provided one tool for COPD treatment initiation and escalation or de-escalation. Following the release of new guidelines by the Global Initiative for Chronic Obstructive Lung Disease (GOLD 2020) and the Asthma + Respiratory Foundation NZ (NZ COPD guidelines 2021), the prescribing tool has been updated and now includes a second clinical resource to be used at follow-up, after medicines have been initiated.

Update (2023)

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) has released a 2023 report on the prevention, diagnosis and management of COPD. It contains a number of updated recommendations, including:

  • A revised “ABE” assessment tool for predicting patient outcomes and making treatment decisions. This recognises the clinical relevance of exacerbations, regardless of the patient’s symptom severity (i.e. categories “C” and “D” in the “ABCD” tool are now combined into a single “E” category).
  • LABA/LAMA combination treatment is now recommended as the first-line option in patients requiring a long-acting bronchodilator, including those who are more symptomatic or at high exacerbation risk. This supersedes previous guidance to use LAMA or LABA monotherapy first.
  • Use of an ICS + LABA alone is now discouraged throughout COPD management unless prescribed for a concurrent diagnosis such as asthma

Given these significant changes, we plan to update our COPD tools. However, we will await any revision of New Zealand guidelines in accordance with the GOLD 2023 report. In addition, Special Authority approval criteria for LABA/LAMA combinations currently require patients to be stabilised on LAMA monotherapy first, making these recommendations difficult to apply equitably in practice.

Tool 1

Treatment initiation

The patient has been diagnosed with COPD but has not been prescribed long-term inhaled medicines to manage their condition

View tool

Tool 2

Escalation or de-escalation of treatment

The patient is currently taking long-term inhaled medicines for the management of COPD and they are likely to benefit from escalation or de-escalation of treatment

View tool

Made with by the bpacnz team

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