East Sussex - Better Together

COPD - Stepping up and Stepping down Treatment

COPD step up

Remember LABA and LAMA reduce exacerbations

Before stepping up treatment ensure you check:

Therapy compliance

Technique with inhalers

Trigger factors

  • 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

  • First Line Drugs
  • Second Line Drugs
  • Specialist Initiated Drugs
  • Specialist Only Drugs
  • Mixed Status