Inhaled bronchodilator1 prn (COPD Category A)2

¹ Drugs limited to those available in U.S., listed in alpha order. <br>• <b>Not recommended:</b> Mucolytics [D], regular antitussive use [D], long-term oral/inhaled steroid monotherapy [A], antibiotics other than for infectious exacerbations [B]. Adding SABA in high doses to LABA not recommended. Oral steroid trial: No evidence supports short-term PO steroid trial to identify steroid-responsive pts.<br>
• No existing COPD med has conclusively been shown to modify lung-function decline long-term.
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² Category A = few sx, low exacerbation risk. Exacerbation = acute worsening (beyond day-to-day variation) leading to change in medication.
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³ Brief cessation counseling:<br>
• <b>Ask</b> @ tobacco use @ every visit for tobacco users; use office-wide identification system<br>
• <b>Advise</b> quitting in a clear, strong, personalized manner<br>
• <b>Assess</b> willingness to quit, determine when (eg, w/in next 30 days)<br>
• <b>Assist</b> w/ quit plan, including practical counseling, exploring social support, prescribing pharmaco-tx, educational resources<br>
• <b>Arrange</b> follow-up in person or via phone, etc.