Fast Five Quiz: Chronic Obstructive Pulmonary Disease Maintenance Therapy

Zab Mosenifar, MD


July 22, 2022

Long-term oxygen therapy may improve survival in patients with severe resting chronic hypoxemia. According to a meta-analysis by Wu and colleagues, it may also relieve dyspnea and improve exercise capacity and health-related quality of life.

The use of systemic steroids in the treatment of acute COPD exacerbations is broadly accepted and recommended, given their high efficacy. However, maintenance therapy with oral steroid is discouraged in light of their adverse effects (eg, hypertension, glucose intolerance, osteoporosis, fractures, and cataracts). This applies to all patients with COPD, including those with a history of severe and frequent exacerbations despite the use of otherwise optimal therapy.

For most patients with COPD who are receiving triple therapy (ICS/LABA/LAMA) and have had no exacerbations in the past year, ICS can be withdrawn, per recent American Thoracic Society Clinical Practice Guidelines.

In individuals with COPD who experience advanced refractory dyspnea despite otherwise optimal therapy, opioid-based therapy may be considered for palliative relief. This decision should be made within the context of a personalized shared decision-making approach.

Learn more about the management of COPD.

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