Treatment

Video

Document Overview

Design and created by Guideline Central in participation with the American Thoracic Society.

Pharmacologic Management of Chronic Obstructive Pulmonary Disease

American Thoracic Society

Publication Date: Apr 1, 2020

Page Last Updated: May 5, 2026

Interpretation of strong and conditional (weak) recommendations

	Strong recommendation	Conditional (weak) recommendation
Patients	Most individuals in this situation would want the recommended course of action, and only a small proportion would not.	The majority of individuals in this situation would want the suggested course of action, but many would not.
Clinicians	Most individuals should receive the intervention. Adherence to this recommendation according to the guideline could be used as a quality criterion or performance indicator. Formal decision aids are not likely to be needed to help individuals make decisions consistent with their values and preferences.	Recognize that different choices will be appropriate for individual patients and that you must help each patient arrive at a management decision consistent with his or her values and preferences. Decision aids may be useful in helping individuals to make decisions consistent with their values and preferences.
Policy makers	The recommendation can be adopted as policy in most situations.	Policymaking will require substantial debate and involvement of various stakeholders.

Document Overview

Document Title: Pharmacologic Management of Chronic Obstructive Pulmonary Disease

Authoring Society: American Thoracic Society

Document Publication Date: Apr 1, 2020

Page Last Reviewed/Updated: May 5, 2026

Document Type: Guideline

Country of Publication: United States

Full Text Freely Available: Yes

Full Text Guideline: www.atsjournals.org/doi/full/10.1164/rccm.202003-0625ST

Source Citation: Nici, L., Mammen, M., Charbek, E., et al. Pharmacologic Management of COPD: An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med, 2020;201(9), pp.e56–e69.

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

Document Objectives: This document provides clinical recommendations for the pharmacologic treatment of chronic obstructive pulmonary disease (COPD). It represents a collaborative effort on the part of a panel of expert COPD clinicians and researchers along with a team of methodologists under the guidance of the American Thoracic Society.

Scope: Assessment and Screening, Management, Prevention, Treatment

Diseases/Conditions (MeSH)

D029424 - Pulmonary Disease, Chronic Obstructive

Keywords: COPD, Pharmacotheraphy, dyspnea, exacerbation, steroids

Target Patient Population: patients with COPD

Inclusion Criteria: Male, Female, Adult, Older Adult

Health Care Settings: Ambulatory

Intended Users: Nurse, Nurse Practitioner, Physician, Physician Assistant, Respiratory Therapist, Social Worker

Recommendation Development Processes & Methodology

PICO Questions

In Patients with COPD Who Complain of Dyspnea or Exercise Intolerance, Is LABA/LAMA Combination Therapy More Effective than and as Safe as LABA or LAMA Monotherapy?
In Patients with COPD Who Complain of Dyspnea or Exercise Intolerance despite the Use of Dual Therapy with LABA/LAMA, Is Triple Therapy with ICS/LABA/LAMA More Effective than and as Safe as Dual Therapy with LABA/LAMA?
In Patients with COPD Who Are Receiving Triple Therapy (ICS/LABA/LAMA), Should the ICS Be Withdrawn?
In Patients with COPD and Blood Eosinophilia, Should Treatment Include an ICS in Addition to a Long-Acting Bronchodilator?
In Patients with COPD Who Have a History of Severe and Frequent Exacerbations despite Otherwise Optimal Therapy, Is Maintenance Oral Steroid Therapy More Effective than and as Safe as No Maintenance Oral Steroid Therapy?
In Patients with COPD Who Experience Advanced Refractory Dyspnea despite Otherwise Optimal Therapy, Is Opioid-based Therapy More Effective than and as Safe as No Additional Therapy?

Supplemental Methodology Resource: Data Supplement

Number of Source Documents: 59

Literature Search Start Date: Monday, January 1, 1990

Literature Search End Date: Thursday, January 31, 2019

Includes peer/external review process?: Yes

Includes public comment process?: No

Methodologist involvement?: Yes

Patient involvement?: No

Includes multi-disciplinary group?: Yes

Includes systematic review?: Yes

Grades quality of strength of evidence?: Yes

Grades quality of strength of recommendation?: Yes

Discloses funding source?: Yes

Discloses conflicts of interest?: Yes

Includes benefits/harms analysis with recommendations?: Yes

Identifies study selection process?: Yes

Identifies study selection criteria?: Yes

Identifies methods used to evaluate and analyze the evidence?: Yes

Identifies key questions addressed by the systematic review?: Yes

Identifies search strategy?: Yes