Updated Canadian guidelines on pharmacotherapy of stable COPD

The Canadian Thoracic Society (CTS) has published updated guidelines on pharmacotherapy in patients with stable chronic obstructive pulmonary disease (COPD). The 2023 guidelines update those last published in 2019. The CTS stresses that there is an urgent need to offer effective and personalized management plans for individuals living with COPD, to improve symptoms and health status, prevent acute exacerbations and reduce mortality. The updated guidelines place high value on the alleviation of symptoms, particularly dyspnea, which is the most debilitating symptom in COPD. The CTS recommends a comprehensive approach to COPD management that includes confirming the diagnosis of COPD with spirometry, evaluating symptom burden, health status and risk of exacerbations over time, and implementing pharmacologic and nonpharmacologic treatments. Evidence-based nonpharmacologic interventions are vital for effective comprehensive management of COPD. These include smoking cessation counselling, vaccinations, self-management education and pulmonary rehabilitation. The 2023 COPD guideline update focuses on three main areas: Alleviating symptom burden (e.g., dyspnea and exercise intolerance, improving health status) Preventing acute exacerbations of COPD, and Reducing mortality. Recommendations for each of these three areas are summarized in separate tables. In addition, numerous key changes from the previous COPD guidelines are summarized in the text of the guidelines. An important change since 2019 is the recommendation for use of long-acting bronchodilator maintenance therapy in all individuals with COPD who have persistent (even mild) symptoms. Also, in individuals with moderate to severe dyspnea, and individuals with moderate to severe reduced health status, long-acting muscarinic antagonist/long-acting beta2-agonist (LAMA/LABA) dual therapy is strongly recommended over LAMA or LABA monotherapy. The 2023 guidelines also include a revised figure (pathway) summarizing COPD pharmacotherapy. When triple inhaled LAMA/LABA/inhaled corticosteroid (ICS) therapy is required, single inhaler triple therapy is preferred over multiple inhalers, because of potential increased benefits, increased adherence and reduced chance of errors in inhaler technique. The CTS plans to review the COPD guidelines annually to determine the need for any updates, in accordance with the CTS Living Guideline Model. Reference 1. Bourbeau J, Bhutani M, Hernandez P, at al. 2023 Canadian Thoracic Society guideline on pharmacotherapy in patients with stable COPD. Can J Respir Crit Care Sleep Med 2023; Published online September 8, 2023. (accessed September 19, 2023).

Updated Canadian guidelines on pharmacotherapy of stable COPD

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