COPD Guidelines: A Review of the 2018 GOLD Report Shireen Mirza, MBBS, Ryan D. Clay, MD, Matthew A. Koslow, MD, Paul D. Scanlon, MD  Mayo Clinic Proceedings  Volume 93, Issue 10, Pages 1488-1502 (October 2018) DOI: 10.1016/j.mayocp.2018.05.026 Copyright © 2018 Mayo Foundation for Medical Education and Research Terms and Conditions

Figure 3 Proposed step-wise algorithm based on usual clinical practice. aICS = inhaled corticosteroid; LABA = long-acting beta agonist; LAMA = long-acting muscarinic antagonist; SABA = short-acting beta agonist; SAMA = short-acting muscarinic antagonist. bRoflumilast may be considered for patients with severe-very severe obstruction with chronic bronchitis and frequent exacerbations. cMucolytics may be considered in patients with chronic bronchitis and frequent exacerbations. dAzithromycin may be considered for reduction of exacerbations in former smokers over age 65 and mild airflow obstruction. eAvoid routine concomitant SAMA use when on LAMA. Mayo Clinic Proceedings 2018 93, 1488-1502DOI: (10.1016/j.mayocp.2018.05.026) Copyright © 2018 Mayo Foundation for Medical Education and Research Terms and Conditions