Chronic obstructive pulmonary disease (COPD) is a progressive lung condition that causes breathing problems. The COPD treatment algorithm can help ensure a person receives suitable treatment to help ease symptoms and slow the condition’s progression.

COPD is a chronic condition that impairs breathing and may include emphysema, chronic bronchitis, or both. People with COPD have long-term respiratory symptoms, such as:

  • shortness of breath
  • wheezing
  • coughing
  • chest tightness

Currently, there is no cure for COPD, but some treatments can slow its progression and reduce symptoms. COPD treatment algorithms provide a set of protocols and a guide for treatment.

The article below looks at COPD treatment algorithms, including the Global Initiative for Chronic Obstructive Lung Disease (GOLD) assessment tool.

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Doctors individualize COPD treatment to meet the needs of the person with the disease. However, COPD treatment algorithms provide doctors with treatment protocols as part of an initial plan.

The COPD treatment algorithm involves a set of guidelines according to factors, such as symptoms or severity of disease, to treat someone with the condition. Effectively treating COPD may involve a varied approach, depending on how frequently someone has an increase or flare-up of symptoms.

Different COPD treatment algorithms exist, such as GOLD and the National Institute for Health Care Excellence (NICE) protocol.

Both treatment protocols offer initial management recommendations for COPD and include the following:

  • smoking cessation counseling
  • vaccination to reduce the risk of the flu and COVID-19
  • regular exercise
  • self-management education, such as inhaler techniques, managing breathlessness, and reducing risk factors for flare-ups
  • proper management of co-existing medical conditions

The GOLD COPD assessment tool is a key resource in treating COPD and provides an algorithm for treatment protocols. Doctors widely use the GOLD algorithm to implement initial treatment guidelines. They may also change treatment according to individual responses.

The annual GOLD report reviews research from the previous year and develops recommendations for managing and preventing COPD.

Previously, the GOLD algorithm used symptom severity and the frequency of flare-ups to categorize treatment protocols. Researchers divided the categories into A, B, C, and D.

The GOLD Strategy Reports revises or changes its protocols periodically. In 2023, the GOLD algorithm became updated and combined category C and D into category E. The report recommendations take the frequency of exacerbations and hospitalizations due to COPD to determine treatment.

The 2023 GOLD algorithm also provides treatment guidance that derives partly from blood eosinophil levels. Eosinophils are a type of white blood cell relating to an immune system response. In some cases, people with COPD have increased eosinophil levels.

The 2023 GOLD treatment protocols include those below.

Someone in the category group A typically has milder COPD than the other groups. Group A treatment includes a long-acting bronchodilator, including either a long-acting beta-agonist (LABA) or a long-acting muscarinic antagonist (LAMA).

A LABA is a type of bronchodilator that relaxes the smooth muscles in the airways to reduce constriction or narrowing of the airway. Long-acting indicates the medication reduces symptoms for several hours. The dosing for a LABA is once or twice a day. LABAs include:

  • arformoterol tartrate (Borvana)
  • salmeterol (Serevent)
  • olodaterol (Striverdi Respimat)

LAMAs are also a type of bronchodilator. They block the neurotransmitter acetylcholine, which may cause constriction of the airways. LAMAs are one of the most frequently recommended first-line treatment options for people with COPD.

Examples of LAMAs include:

People in treatment group B may have more significant COPD symptoms than those in group A. Initial treatment recommendations for group B include LABA and LAMA medication. This type of inhaler contains both a LABA and LAMA. Examples include:

  • umeclidinium and vilanterol (Anoro)
  • olodaterol and vilanterol (Stiolto)
  • glycopyrrolate and formoterol (Bevespi)

Doctors also recommend pulmonary rehabilitation, which involves education and monitored exercise to people in group B.

GOLD combined previous treatment categories C and D into the E category. Individuals in treatment group E likely experience two or more moderate exacerbations of the disease within a year or one flare-up requiring hospitalization.

The E treatment group also considers eosinophil levels. Guidelines for treatment include initial treatment with dual bronchodilators with LABA and LAMA. For people who have eosinophil levels of 300 or more, treatment includes a LABA, LAMA, and inhaled corticosteroids.

Some doctors may prescribe a LABA, LAMA inhaler, and a separate inhaled corticosteroid inhaler.

Currently, a few triple therapy inhalers are available that contain a LABA, LAMA, and an inhaled steroid. Examples include Trelegy Ellipta, which contains fluticasone, vilanterol, and umeclidinium, and Breztri Aerosphere, which contains budesonide, glycopyrrolate, and formoterol fumarate.

Treatment may also include an inhaled corticosteroid if someone has COPD and also a diagnosis of asthma. Group E treatment also includes pulmonary rehabilitation.

COPD is a long-term lung disease that may worsen over time. Although there is currently no cure, treatment may help reduce symptoms and flare-ups. COPD treatment algorithms provide a set of guidelines for treating COPD according to symptom severity and frequency of flare-ups.

Doctors widely use the GOLD assessment tool to categorize COPD treatment. GOLD divides COPD into groups A, B, and E and provides treatment recommendations.