The COPD prescribing tool for initiating medicines
This tool provides guidance on the initiation of medicines for patients with COPD based on their symptom severity and exacerbation history.
This tool is NOT intended to be used for the escalation or de-escalation of treatment at follow-up (see Tool
Choose category A, B, C or D which corresponds to the severity of the patient’s
symptoms. Assessment criteria and treatment options are taken from the Global Strategy for the Diagnosis, Management and Prevention of COPD
An algorithm for the escalation or de-escalation of pharmacological treatment is available in GOLD, Figure 4.4, page 85.
This tool contains the updated recommendation that long-acting muscarinic antagonists (LAMAs)
are generally preferred over long-acting beta2-agonists (LABAs) for patients requiring long-acting bronchodilator monotherapy as well as several funding changes for inhaled medicines.
Remember: Non-pharmacological interventions are first-line
In COPD management, non-pharmacological interventions are the most effective way to improve symptom control
and quality of life and modify disease progression, regardless of what pharmacological treatments are ultimately required. Non-pharmacological interventions include:
- Smoking cessation; the most important factor to improve symptoms and slow disease progression
- Regular exercise; at least 20 – 30 minutes per day, ideally more if fitness allows
- Pulmonary rehabilitation; offered to all patients where available, as it improves breathlessness substantially more than inhaled medicines
(see Appendices 4 and 5 of the NZ COPD guidelines for some non-pharmacological strategies for breathlessness:
- Creating a written COPD action plan indicating what to do if the patient’s condition deteriorates - an example plan is provided in
Appendix 3 of the NZ COPD guideline
- Annual influenza immunisation and appropriate pneumococcal immunisation reduces the risk of serious respiratory
infections and COPD exacerbations
Further information on pulmonary rehabilitation is available from: