• Reference [2,5]
SPIROMETRY FINDINGS IN COPD
Severity FEV₁/FVC
(post-bronchodilator)
FEV₁
(% predicted
post-bronchodilator)
Mild COPD
(GOLD 1)
≤ 0.7 ≥ 80%
Moderate COPD
(GOLD 2)
≤ 0.7 50 - 80%
Severe COPD
(GOLD 3)
≤ 0.7 30 - 50%
Very Severe COPD
(GOLD 4)
≤ 0.7 < 30%



  • Reference [1]
2011 ACP / ATS / ACCP / ERS recommendations
ALL PATIENTS
  • SABA +/- SAMA as needed
  • Tobacco cessation if smoker
STABLE PATIENTS WITH FEV₁ 60 - 80% OF PREDICTED
  • SABA +/- SAMA as needed
  • LABA or LAMA may be used
STABLE PATIENTS WITH FEV₁ < 60% OF PREDICTED
  • SABA +/- SAMA as needed
  • LABA or LAMA
  • Combination therapy (LABA +/- LAMA +/- ICS) may be used in some patients
STABLE PATIENTS WITH FEV₁ < 50% OF PREDICTED
  • SABA +/- SAMA as needed
  • LABA or LAMA
  • Combination therapy (LABA +/- LAMA +/- ICS) may be used in some patients
  • Pulmonary rehabilitation (exercise therapy, smoking cessation, etc.)
INDICATIONS FOR CONTINUOUS OXYGEN THERAPY
  • COPD patients with resting hypoxemia of PaO₂ ≤ 55 mmHg or SpO₂ ≤ 88%
  • Physiologic indications for the use of long-term oxygen therapy include cor pulmonale or polycythemia with PaO₂ between 55 and 59 mmHg
  • The therapeutic goal is to maintain SpO₂ > 90% during rest, sleep, and exertion [1,2]
  • See oxygen measurements below

  • Reference [5]
GOLD 2017 recommendations
Step 1 - Assign patient a group
  • Symptom score
  • Exacerbation history within past year
    • Mild: None or one that did not require hospitalization
    • Moderate/severe: ≥ 2 or ≥ 1 that required hospitalization
GROUP A: mMRC 0 - 1 or CAT < 10 and Mild exacerbation history
  • SABA or SAMA as needed
GROUP B: mMRC ≥ 2 or CAT ≥ 10 and Mild exacerbation history
  • SABA or SAMA as needed
  • LAMA or LABA
  • If necessary, progress to LAMA + LABA
GROUP C: mMRC 0 - 1 or CAT < 10 and Moderate/severe exacerbation history
  • SABA or SAMA as needed
  • LAMA
  • If necessary, progress to LAMA + LABA (preferred) or LABA + ICS
GROUP D: mMRC ≥ 2 or CAT ≥ 10 and Moderate/severe exacerbation history
  • SABA or SAMA as needed
  • LAMA
  • If necessary, progress to LAMA + LABA (preferred) or LABA + ICS
  • If still uncontrolled, progress to LAMA + LABA + ICS (triple therapy)
  • For patients who are uncontrolled on triple therapy, consider the following:
    • Consider roflumilast if FEV₁ < 50% of predicted and patients has chronic bronchitis
    • Consider macrolide in former smokers
INDICATIONS FOR CONTINUOUS OXYGEN THERAPY
  • COPD patients with resting hypoxemia of PaO₂ ≤ 55 mmHg or SpO₂ ≤ 88% with or without hypercapnia confirmed twice over a 3-week period; OR
  • PaO₂ between 55 mmHg and 60 mmHg or SpO₂ of 88% if there is evidence of pulmonary hypertension, peripheral edema suggesting congestive heart failure, or polycythaemia (hematocrit > 55%)
  • See oxygen measurements below




Reference [4]
NORMAL ABG VALUES
Measure Normal range
pH 7.3 - 7.5
PaO₂ ≥ 80 mmHg
PaCO₂ 30 - 50 mmHg
HCO₃ 21 - 27 mEq/L
SaO₂ ≥ 95%


Reference [4]
RELATION BETWEEN PaO₂ and SaO₂
Degree of hypoxemia PaO₂ SaO₂
Normal ≥ 80 mmHg 95 - 100%
Mild 60 - 79 mmHg 90 - 94
Moderate 40 - 59 mmHg 75 - 89%
Severe < 40 mmHg < 75%