1) Offer SABA or SAMA as needed for symptom relief.
Then, if there are ongoing symptoms or exacerbations:
2) Offer LABA+LAMA
Then, if there are still ongoing symptoms or exacerbations:
The added value of inhaled corticosteroids will vary from person to person and may be marginal.
|If the aim of treatment is to improve daily symptoms:
|If the aim of treatment is to reduce exacerbations*, regardless of any day-to-day symptomatic benefit:
*NICE suggests a baseline level of exacerbations to consider starting ICS to be 1 severe (requiring hospitalisation) or 2 moderate (requiring steroids or antibiotics) exacerbations per year.
SABA, short-acting beta agonist; SAMA, short-acting muscarinic antagonist; LAMA, long-acting muscarinic antagonist; LABA, long-acting beta agonist; ICS: inhaled corticosteroid.
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