Short Acting Beta Agonists (SABAs) Albuterol (ProAir, Proventil, Ventolin) MDI PRN Albuterol Nebulized solution PRN Albuterol (ProAir) Respiclick (DPI) PRN Levalbuterol (Xopenex) MDI, Nebulized solution PRN Short Acting Muscarinic Antagonist (SAMAs) Ipratropium (Atrovent) MDI, Nebulized solution PRN SABA/SAMA Albuterol/Ipratropium (Combivent) Respimat (SMI), PRN Nebulized solution Long Acting Beta Agonists (LABAs) Arformoterol (Brovana) Nebulized solution BID Formoterol (Perforomist) Nebulized solution BID Indacaterol (Arcapta) Neohaler (DPI) Daily Olodaterol (Striverdi) Respimat (SMI) Daily Salmterol (Serevent) Diskus (DPI) BID Long Acting Muscarinic Antagonists (LAMAs) Aclidinium (Tudorza) Pressair (DPI) BID Glycopyrrolate (Seebri, Lonhala Magnair) Neohaler (DPI), BID Nebulized solution Tiotropium (Spiriva) Handihaler (DPI), Daily Respimat (SMI) Umeclidinium (Incruse) Ellipta (DPI) Daily LABA/LAMA Formoterol/Glycopyrrolate (Bevespi) Aerosphere (MDI) BID Indacaterol/Glycopyrrolate (Utibron) Neohaler (DPI) BID Vilanterol/Umeclidinium (Anoro) Ellipta (DPI) Daily Olodaterol/Tiotropium (Stiolto) Respimat (SMI) Daily Flip over for: LABA/Inhaled corticosteroid (ICS) and ICS KEY - MDI: Metered dose inhaler, DPI: Dry powder inhaler, SMI: Soft mist inhaler

GOLD Guideline Treatment Summary Group C Group D LAMA or > 2 moderate exacerbations or > 1 LAMA LAMA + LABA* or leading to hospitalization ICS + LABA** Group A Group B A Long Acting 0 to 1 moderate exacerbations (not A Bronchodilator Bronchodilator leading to hospital (LABA or LAMA) mMRC 0-1, CAT <10 mMRC > 2, CAT >10 * Consider if highly symptomatic, e.g. CAT > 20 ** Consider if eos > 300

Reference: GOLD Report 2019 Available at: https://goldcopd.org/gold-reports/ LABA/Inhaled Corticosteroid (ICS) Low Moderate High 80-4.5 160-4.5 Formeoterol-Budesonide (Symbicort) MDI - 2 puff BID 2 puff BID 100-5 200-5 Formoterol-Mometasone (Dulera) MDI - 2 puff BID 2 puff BID

Diskus (DPI) 100-50 250-50 500-50 1 inhal BID 1 inhal BID 1 inhal BID Salmeterol-Fluticasone (Advair) 45-21 115-21 230-21 MDI 2 puff BID 2 puff BID 2 puff BID

55-14 113-14 232-14 Salmterol-Fluticasone (Air Duo) Respiclick (DPI) 1 inhal BID 1 inhal BID 1 inhal BID

100-25 200-25 Vilanterol-Fluticasone (Breo) Ellipta (DPI) - 1 inhal QD 1 inhal QD ICS 40 1-2 BID - - Beclomethasone (Qvar) Redihaler (MDI) 80 1 BID 2 BID 3 BID 90 1-2 BID - - Budesonide (Pulmicort) Flexhaler (DPI) 180 1 BID 2 BID 3 BID 80 1 BID 2 BID - Ciclesonide (Alvesco) MDI 160 - 1 BID 2 BID 44 1-2 BID - - MDI 110 1 BID 2 BID - 220 - 1 BID 2 BID Fluticasone (Flovent) 50 1-2 BID - - Diskus (DPI) 100 1 BID 2 BID - 250 - 1 BID 2 BID 100 - 1 QD - Fluticasone furoate (Arnuity) Ellipta (DPI) 200 - - 1QD 100 1 BID 2 BID - MDI 200 - 1 BID 2 BID Mometasone (Asmanex) 110 1 BID 2 BID - Twisthaler ( DPI) 220 - 1 BID 2 BID

References: NHLBI Asthma Quick Guide 2012 Available at: https://www.nhlbi.nih.gov/files/docs/guidelines/asthma_qrg.pdf "Estimated comparative daily doses for inhaled glucocorticoids in adolescents and adults" UpToDate 2019.