COPD pt group: A, B,C,D

A&B: Gold 1&2
C&D: Gold 3&4

A: Short-acting anticholinergic or SABA
B: Long-acting anticholinergic or LABA
C: ICS + LABA or ICS+long-acting anticholinergic
D: ICS+LABA and/or Long-acting anticholinergic

Explanaation:

So..... there are 3 main groups in COPD: Beta Adrenergics, Anticholinergics, & Steroids (ICS - Inhaled corticosteroids).  To start off,  you will mostly wanna use bronchodilators such as beta adrenergic or anticholinergics (pt A&B). Then, if you can't really control COPD, then you will add a steroids (bc COPD is a little bit still an inflammation disease), you'd move on to ICS. When you use ICS, you wanna make a combo of ICS & LABA mostly, but u can also make ICS & Long-Acting anticholinergics (Pt C). In the worst case scenario, you can add all 3 classes together: ICS+LABA+long-acting anticholinergic (D).

Remember anti-inflammation is not that big a deal in COPD. COPD's hallmark is the bronchodilators. The bronchodilators would include SABA such as albuterol or Long-acting anticholinergic agents (ipratropium or aclidinium/umeclidinium, tiotropium, or glycopyrrolate) (pt group A).

When pt needs to use those SABA/Short-acting anticholinergics. Then, you want to control COPD so that pt will use these short-acting agents a little less. So, in order to do that, you want to use LABA or  long-acting anticholinergics (Group B)

When pt is still not controlled with those long-acting, you'll wanna add ICS. See? Unlike asthma, you don't add ICS that early. So you wanna use ICS with LABA or ICS with long-acting anticholinergics (group C).

And, finally, very rarely, in very severe cases, you can add all drugs: ICS, LABA and long-acting anticholinergics.

~Wonder Me!