COPD
NZ COPD 2025 guidelines. Key Recommendations for pharmacological management of COPD.
NZ COPD 2025 guidelines : https://www.asthmafoundation.org.nz/assets/documents/NZ-COPD-Guidelines-2025-FINAL.pdf
COPD-X 2025 :
Lung Foundation Australia infographic summary :
https://lungfoundation.com.au/wp-content/uploads/2025/06/COPD_Stepwise_Digital.pdf
Key Non-pharmacological Recommendations:
• Smoking cessation is the most important component of management, and every patient who is still smoking should be offered help to quit.
• Offer pulmonary rehabilitation to all patients with COPD who are limited by their breathing.
• Promote regular exercise (20–30 minutes per day).
• Address obesity and under-nutrition.
• Some patients will benefit from review by a respiratory physiotherapist and breathing exercises.
• Individual breathlessness plans, including handheld fan therapy, can help manage symptoms.
• Complete self-management plan.
• A few carefully selected patients may benefit from thoracic surgery, endobronchial valve therapy or referral for transplantation. These options should be considered as part of respiratory specialist review
in secondary care.
Key Recommendations for pharmacological management of COPD.
• Inhaler technique, device suitability, and adherence to treatment should be reviewed regularly and before any medication changes.
• LAMA as the first-line long-acting bronchodilator, both for breathlessness and reduction of exacerbation risk.
• Prompt escalation to LAMA/LABA in most patients.
• The main role for ICS is to prevent exacerbations in patients with frequent exacerbations.
• Higher blood eosinophils (≥300 cells/μL) are associated with a greater response to ICS and may identify patients who should receive ICS/LAMA/LABA.
• Patients with asthma/COPD overlap should receive ICS.
• For patients requiring ICS/LAMA/LABA, a single combined inhaler should be considered for improved adherence.
• Within each drug class, choice of treatment should be guided by a patient’s preference for inhaler device.
• Treatment should be escalated quickly for patients with severe COPD or frequent exacerbations.
• All patients should have a written/electronic personalised COPD action plan (see Appendix 4).
Do not:
• Do not prescribe regular SABA.
• Do not routinely prescribe a SAMA to patients on a LAMA.
• Do not prescribe long-term oral corticosteroids as maintenance therapy for COPD.
• Do not routinely prescribe theophylline.
• Do not use short-term response to bronchodilator (e.g., bronchodilator responsivness testing) to predict
benefit from long-term bronchodilator therapy.
• Do not prescribe nebulised bronchodilators in patients with stable COPD.
• Do not withdraw ICS in patients with asthma/COPD overlap or raised blood eosinophils.
