Current treatment

Suggested changes

LABA or LAMA

– LABA + LAMA

or

– LABA + ICS (consider in patients with eosinophil count ≥0.3×109/L or in those with eosinophil count ≥0.1×109/L and exacerbations [≥2/y or ≥1 hospitalization])

LABA + LAMA

– Eosinophil count ≥0.1×109/L: LABA + LAMA + ICS

– Eosinophil count <0.1×109/L: Consider roflumilasta or azithromycin (in ex-smokers) or theophyllineb

LABA + ICS

– LABA + LAMA + ICS

or

– LABA + LAMA (consider in case of recent pneumonia, lack of indications for ICS, or lack of response to ICS treatment)

LABA + LAMA + ICS

– Roflumilasta or azithromycin (in ex-smokers) or theophyllineb

or

– LABA + LAMA (consider in case of recent pneumonia, lack of indications for ICS, or lack of response to ICS treatment)

a In patients with FEV1 <50% and chronic cough with sputum production.

b Not used often in resource-rich countries.