Preferred first treatment choice
| Patient type 1 | Patient type 2 | Patient type 3 | Patient type 4 | |
| Czech Republic# | Bronchitic: standard treatment + one or more options: PDE4 inhibitor if exacerbator, mucoactive drugs or antibiotics | Emphysematous: standard treatment + one or more options: theophylline, BVR, LVRS, bullectomy or α1-AT | Frequent exacerbator: standard treatment + one or more options: PDE4 inhibitor, ICS + LABA, mucoactive drugs or antibiotics | ACOS: standard treatment + one or more options: ICS + LABA, ICS + LABA + LAMA or anti-leukotrienes |
| England and Wales | Breathlessness and exercise limitation: SABA or SAMA | Exacerbations or breathlessness and FEV1 ≥50% pred: LABA or LAMA | Exacerbations or breathlessness and FEV1 <50%: LAMA or ICS + LABA | Persistent exacerbations or breathlessness: ICS + LABA or LABA + LAMA if ICS declined or not tolerated or LAMA + ICS + LABA |
| Finland | Low risk for exacerbations: SABA or SAMA | Low risk for exacerbations: LABA or LAMA | High risk for exacerbations: LAMA or ICS + LABA | ACOS: at least ICS + LABA or ICS + LABA + LAMA |
| France | GOLD 1: SABA or SAMA (or both) | GOLD 2: LABA or LAMA (both if dyspnoea persists during usual exercise) | GOLD 3: ICS + LABA if repeated exacerbations or LABA + LAMA | GOLD 4: triple therapy (ICS + LABA + LAMA) if previous step is not sufficient |
| Germany | GOLD 1: avoidance of risk factors; vaccination(s); and SABA | GOLD 2: add LABA(s) and rehabilitation | GOLD 3: add ICS in patients with frequent exacerbations | GOLD 4: add LTOT; possible indication for surgery |
| Italy | Symptomatic with confirmed diagnosis of COPD, mMRC stage ≥1 and prebronchodilator FEV1 ≥80% pred: consider treatment with bronchodilators | Symptomatic with confirmed diagnosis of COPD and prebronchodilator FEV1 <80% pred: consider LABA | If patient /physician not satisfied: increase bronchodilator dose; add second category LABD; add ICS in frequent exacerbators | |
| Poland | CAT <10, FEV1 ≥50% pred, low exacerbation: SABA or SAMA | CAT ≥10, FEV1 ≥50% pred, low exacerbation: LABA or LAMA | CAT <10, FEV1 <50% pred, high exacerbation: LAMA or ICS + LABA | CAT ≥10, FEV1 <50% pred, high exacerbation: LAMA and/or ICS + LABA |
| Portugal | GOLD A: SABA or SAMA | GOLD B: LABA or LAMA | GOLD C: LAMA or ICS + LABA | GOLD D: LAMA and/or ICS + LABA |
| Russia | GOLD A: SABA or SAMA | GOLD B: LABA or LAMA | GOLD C: LAMA or ICS + LABA | GOLD D: ICS + LABA, LAMA, ICS + LABA + LAMA |
| Spain | Nonexacerbator: LAMA or LABA | ACOS: ICS + LABA | Exacerbator with chronic bronchitis: LAMA or ICS + LABA | Exacerbators with emphysema: LAMA or ICS + LABA |
| Sweden | GOLD A: SABA or SAMA | GOLD B: LAMA | GOLD C: ICS + LAMA or ICS + LABA + LAMA | GOLD D: LAMA + LABA + ICS |
PDE: phosphodiesterase; BVR: bronchoscopic volume reduction; LVRS: lung volume reduction surgery; α1-AT: α1-antitrypsin; ICS: inhaled corticosteroid; LABA: long-acting β2-agonist; ACOS: asthma–chronic obstructive pulmonary disease (COPD) overlap syndrome; LAMA: long-acting muscarinic antagonist; SABA: short-acting β2-agonist; SAMA: short-acting muscarinic antagonist; FEV1: forced expiratory volume in 1 s; GOLD: Global Initiative for Chronic Obstructive Lung Disease; LTOT: long-term oxygen therapy; mMRC: modified Medical Research Council; LABD: long-acting bronchodilator; CAT: COPD assessment test. #: recommendations for standard treatments include inhaled bronchodilators (LABA, LAMA, ultra-LABA and ultra-LAMA), pulmonary rehabilitation, vaccination, education, long-acting muscarinic antagonist, inhalation training, dietary changes, comorbidity treatment and risk elimination. Patients with COPD and bronchiectasis receive a PDE4 inhibitor, mucoactive drugs, antibiotics and physiotherapy; and those with pulmonary cachexia receive rehabilitation and nutritional support.