1. Management of Chronic Stable COPD
*Based on GOLD Risk Stratification 2019
Category
Symptoms
Risk
Suggested Treatment
Co- Management
ALL Patients
Short-acting Bronchodilator (rescue)
Self-Management Education
Smoking cessation
Increase Exercise tolerance
Influenza and Pneumococcal vaccination A
Less symptomatic
Mild or infrequent symptoms, breathless with strenuous exercise or when hurrying on level ground or walking up a slight hill
Low Risk
mMRC 0-1 or CAT <10, AND
0 to 1 exacerbations a year not leading to hospital admission
Pharmacologic:
First choice: LAMA or LABA
Primary Care B
More symptomatic:
Moderate to sever symptoms (i.e. Patient has to walk more slowly that others of the same age due to breathlessness, has to stop to catch breath when walking on level ground)
Pharmacologic
Second Choice: LABA/ICS combination in patients eos ≥ 300 or eos ≥100 AND ≥ 2 moderate exacerbations/ 1 hospitalization
Non-Pharmacologic: Pulmonary Rehab C
High Risk
mMRC ≥ 0-1 or CAT ≥ 10, AND
≥ 2 exacerbations a year OR ≥ 1 leading to hospitalization
First choice: LAMA
Consider Referral to Pulmonary Medicine for Co-Management D
First choice: LAMA: Initial therapy
LAMA/LABA: Preferred if highly symptomatic (i.e. CAT >20)
LABA/ICS: Preferred if eos ≥300
Second choice: LAMA/LABA/ICS: Preferred as escalation of therapy if eos ≥ 100 with predominant exacerbations OR if dyspnea is not controlled by LABA/ICS
Primary Care Referral to Pulmonary Medicine for Co- Management
Palliative care referral for COPD Patients with more than 1 hospitalization a year for COPD Exacerbation

2. Hospital Follow Up and Referral Pathways for COPD
Hospital Follow Up for Acute Exacerbation of COPD
Phone Call within 24 hours of Discharge
Office Visit within 3- 7 days with PCP
Refer to Pulmonary if meets criteria
Arrange for Pulmonary follow up, if established patient
Refer to Palliative Care, per criteria below
Referral Pathways
Pulmonary to Consult and Co- Manage: Severe COPD, GOLD Stage D
Pulmonary to Consult and Co- Manage: If 2 or more admissions per year for AE-COPD
Palliative care consult: If ≥ 1 hospitalizations per year for COPD