COPD inhaler strategy for patients WITH features suggesting asthma or steroid responsiveness

1) Offer SABA or SAMA as needed for symptom relief.

Then, if there are ongoing symptoms or exacerbations:

2) Consider LABA+ICS

This combination is suggested as it may confer benefits in the way that it might for someone with asthma.

  • However, the effect will vary between individuals.
  • Be aware that ICS increase the risk of pneumonia and other side effects (see Harms section on the main COPD page).
  • Use clinical judgement about the benefits and risks for an individual and review treatment at appropriate intervals.

Then, if there are:

  • ongoing day to day symptoms that adversely impact quality of life, OR
  • 1 severe (requiring hospitalisation) or 2 moderate (requiring steroids or antibiotics) exacerbations per year or more:


Addition of a LAMA may improve symptoms or reduce the frequency of exacerbation.

  • This is best illustrated in the graphics data comparing LABA v LABA+LAMA.
  • Review treatment at an appropriate interval to consider benefits.


SABA, short-acting beta agonist; SAMA, short-acting muscarinic antagonist; LAMA, long-acting muscarinic antagonist; LABA, long-acting beta agonist; ICS, inhaled corticosteroid.