Recommended Treatment Guidelines for Moderate COPD

Chronic obstructive pulmonary disease (COPD) is classified into four stages according to its severity, with moderate COPD considered stage II of the disease.

Senior man about to use asthma inhaler
Martin Barraud / Getty Images

Overview of Moderate COPD

If you've been diagnosed with moderate COPD, according to the Global Initiative for Obstructive Lung Disease (GOLD), your forced expiratory volume (FEV1) to forced vital capacity (FVC) ratio—as measured by a simple lung test known as spirometry—should be less than 70 percent; and your FEV1 should be between 50 percent and 79 percent of the predicted values for a healthy population.

If you've reached stage II, you're probably just noticing your symptoms—primarily shortness of breath that worsens with activity. You may also start noticing that you're coughing more and have more mucus than you usually do.

You may be wondering if stage II moderate COPD is treated any differently than other stages. Luckily, GOLD has treatment guidelines for every stage of COPD and as your disease progresses, treatment options will be added in an effort to better manage your symptoms.


These are the recommended treatment guidelines for stage II, moderate COPD.

Smoking Cessation

Why quit smoking if you already have COPD? Smoking cessation is the number one goal of treatment, no matter how far along you are in the disease process. Quitting at this stage can dramatically slow the progression of COPD allowing you to live a higher quality of life and live longer. In addition, there are many other health benefits to quitting.

Flu and Pneumonia Vaccines

GOLD guidelines recommend flu and pneumonia vaccines for every stage of COPD treatment. Flu shots help decrease your risk of COPD exacerbation, while the pneumonia vaccine helps prevent bacterial pneumonia, a common cause of COPD exacerbation.

Short-Acting Bronchodilators

Short-acting bronchodilators are commonly referred to as rescue inhalers. Medications such as albuterol and Proventil are recommended on an as-needed basis to manage persistent or worsening COPD symptoms.

Long-Acting Bronchodilators

Long-acting bronchodilators are meant to help people with COPD prevent or reduce symptoms. These medications are generally added to treatment once you reach stage II, moderate COPD. According to GOLD, combining bronchodilators with different modes of action may be more effective than using just one bronchodilator alone, with fewer side effects than increasing the dose of the single inhaler.

This improved effectiveness of combination therapy prompted the American Thoracic Society to recommend that everyone with COPD who experience shortness of breath and/or exercise intolerance be treated with a combination of both a long-acting beta-agonist (LABA) and a long-acting anticholinergic/muscarinic antagonist (LAMA) rather than either of these medications alone.

Examples of long-acting beta-agonists (LABA) include:

  • Performist, Formadil (formoterol)
  • Arcapta Neohaler (indacaterol)
  • Serevent (salmeterol)
  • Brovana (arformeterol)

Examples of long-acting anticholinergics/muscarinic antagonists (LAMA) include:

  • Spiriva (tiotropium bromide)
  • Atrovent (ipatropium)
  • Seebri Neohaler (glycopyrronium)
  • Yupelri (revefenacin)

Examples of inhalers that contain both a LABA and LAMA include:

  • Bevespi Aerosphere (formoterol and glycopyrronium)
  • Utibron Neohaler (indacaterol and glycopyrrolium)
  • Stiolto Respimat (oladaterol and tiotropium bromide)
  • Anoro Ellipta (vilanterol and umeclidinium)

Pulmonary Rehabilitation

Pulmonary rehabilitation utilizes the entire healthcare team to target different areas of your treatment. Studies show that pulmonary rehab helps reduce symptoms, improves your quality of life, decreases social isolation, and increases survival. The program generally consists of a winning combination of exercise training, nutritionists, education, and counseling to help reach its goals.

Proper Nutrition

Healthy nutrition is often overlooked when planning a treatment program. A nutritious diet not only helps you look and feel better, it will give you the extra energy you need to get through your day and breathe more easily. Eating healthy foods may also reduce your risk of lung infections, a common cause of COPD exacerbation.

8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. Wu J, Sin DD. Improved patient outcome with smoking cessation: when is it too late?Int J Chron Obstruct Pulmon Dis. 6:259–267. doi:10.2147/COPD.S10771

  3. Global Initiative for Chronic Obstructive Lung Disease. Respiratory Groups Call for an End to Preventable Pneumonia Deaths - Global Initiative for Chronic Obstructive Lung Disease.

  4. Price DB, Rigazio A, Buatti Small M, Ferro TJ. Historical cohort study examining comparative effectiveness of albuterol inhalers with and without integrated dose counter for patients with asthma or chronic obstructive pulmonary diseaseJ Asthma Allergy. 9:145–154. doi:10.2147/JAA.S111170

  5. Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for the Management and Prevention of Chronic Obstructive Pulmonary Disease 2019 Report.

  6. Nici L, Mammen MJ, Charbek E, et al. Pharmacologic Management of Chronic Obstructive Pulmonary Disease. An Official American Thoracic Society Clinical Practice Guideline. American Journal of Respiratory and Critical Care Medicine. 201(9). doi:10.1164/rccm.202003-0625ST

  7. Corhay JL, Dang DN, Van Cauwenberge H, Louis R. Pulmonary rehabilitation and COPD: providing patients a good environment for optimizing therapyInt J Chron Obstruct Pulmon Dis. 9:27–39. doi:10.2147/COPD.S52012

  8. Berthon BS, Wood LG. Nutrition and respiratory health--feature reviewNutrients. 7(3):1618–1643. doi:10.3390/nu7031618 doi:10.3390%2Fnu7031618

Additional Reading

By Deborah Leader, RN
 Deborah Leader RN, PHN, is a registered nurse and medical writer who focuses on COPD.