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Drugs used in treatment of copd with doses for md exams

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For MD exam quick recall, use this structured list (stable COPD + exacerbation), with common adult doses.

1) Bronchodilators (mainstay)

A. SABA (reliever)

  • Salbutamol (albuterol) MDI: 100 mcg/puff, usually 1-2 puffs q4-6h PRN
  • Nebulized salbutamol: 2.5-5 mg every 4-6 h PRN

B. SAMA

  • Ipratropium MDI: 20 mcg/puff, 2 puffs q6h (or PRN)
  • Nebulized ipratropium: 0.5 mg q6-8h

C. LABA (maintenance)

  • Salmeterol DPI: 50 mcg BID
  • Formoterol DPI: 12 mcg BID
  • Indacaterol: 150-300 mcg OD
  • Olodaterol: 5 mcg OD

D. LAMA (maintenance; preferred long-acting class)

  • Tiotropium: 18 mcg OD (HandiHaler) or 5 mcg OD (Respimat)
  • Glycopyrronium: 50 mcg OD
  • Aclidinium: 400 mcg BID
  • Umeclidinium: 62.5 mcg OD

2) Inhaled corticosteroids (ICS)

Use in selected COPD patients (frequent exacerbations, eosinophilic phenotype, asthma overlap), usually in combination.
  • Budesonide: 200-400 mcg BID (in combo inhaler)
  • Fluticasone propionate: 250-500 mcg BID
  • Fluticasone furoate: 100 mcg OD
Common combos:
  • LABA + ICS: Formoterol/Budesonide, Salmeterol/Fluticasone
  • LABA + LAMA
  • Triple therapy (LABA + LAMA + ICS) for persistent exacerbations

3) PDE-4 inhibitor

  • Roflumilast: 500 mcg PO OD
    (chronic bronchitis phenotype + severe COPD with frequent exacerbations)

4) Methylxanthine (less preferred)

  • Theophylline SR: usually 200-400 mg/day PO (dose adjusted by serum levels, interactions)

5) Mucolytics (selected patients)

  • N-acetylcysteine: 600 mg OD-BID
  • Carbocisteine: 750 mg TID (then maintenance lower dose)

6) Antibiotics in acute exacerbation (if purulent sputum/infection signs)

Typical oral regimens (5-7 days):
  • Amoxicillin-clavulanate: 625 mg TID
  • Azithromycin: 500 mg OD
  • Doxycycline: 100 mg BID (day 1 often 200 mg loading)

7) Systemic steroids in acute exacerbation

  • Prednisolone: 40 mg PO OD for 5 days
    (standard exam dose)

8) Oxygen in exacerbation

  • Controlled oxygen targeting SpO2 88-92% (important exam point)

Exam-friendly stepwise summary

  1. Start maintenance with LAMA or LABA
  2. Persistent symptoms -> LABA + LAMA
  3. Frequent exacerbations/eosinophils high -> add ICS (triple therapy)
  4. Frequent exacerbations despite inhaled therapy -> consider roflumilast, long-term macrolide in selected cases
If you want, I can give this as a one-page MD exam table (drug, class, exact dose, key adverse effects, and when to use).
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