COPD - Stepping up and Stepping down Treatment
COPD step up
Remember LABA and LAMA reduce exacerbations
Before stepping up treatment ensure you check:
Technique with inhalers
- Step up one drug / dosage at a time
- Check equivalent steroid doses if changing drug or device
- Only add inhaled corticosteroid (ICS) in accordance with NICE or GOLD guidelines i.e. patients who are frequently exacerbating
- Review step up with bronchodilators after 4-8 weeks
- Review step up with ICS after 3-6 months
COPD step down
Patients who have FEV1>50%, and have not exacerbated in the past 12 months can be considered suitable for trial of ICS withdrawal to reduce the risk of pneumonia.
Most patients will be on combination products, so step down should be to bronchodilators alone.
There is a theoretical risk of steroid withdrawal at higher doses supporting gradual step down, but local respiratory consultants have endorsed a single withdrawal step in most patients.
Check equivalent steroid doses if changing drug or device.
For more information on use of inhaled corticosteroids in adults see Guidance for Healthcare Professionals
See LABA / ICS Combination inhaler step down guide for more information
- First Line Drugs
- Second Line Drugs
- Specialist Initiated Drugs
- Specialist Only Drugs
- Mixed Status