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Inhaled COPD Treatments




If breathless / exercise limitation:

  • Use a short – acting beta2 agonist (SABA) = salbutamol or terbutaline. SAMA can continue to be used for all stages of COPD. 
    • OR
  • Use a short acting muscurinic antagoinist (SAMA) = ipatropium bromide (but if they’re using it regularly they should be on a LAMA instead – see below)


If Still Breathless

  • Add a long-acting beta 2 – agnoist (LABA) = salmeterol or formoterol
    • OR
  • Add a long-acting muscarinic antagonist (LAMA) = tiotropium
    • if using a LAMA you need to discontinue the SAMA
    • LAMA is preferable to SAMA regular – QDS use


If still breathless or having exacerbations on a LABA…

  • Change the LABA to a combination of LABA and Inhaled corticosteroid (ICS)
  • If ICS not tolerated or declined use LABA in combination with LAMA


If still breathless on LABA + ICS combination

  • Add LAMA

How to remember: