Working Diagnosis.

❏ Clinical tool

COPD Management.

GOLD ABE staging, evidence-based step-up algorithm, BODE prognosis, and a filterable directory of NZ-funded inhalers.

Funding data verified 2026-05-07. Confirm against the live PHARMAC schedule and the NZF before prescribing. Consultation support, not patient self-assessment.

❏ Step 1

Where is the patient?

Spirometry (post-bronchodilator)
Stage threshold uses post-bronchodilator FEV1 only.
Ratio < 0.70 confirms persistent airflow obstruction.
Symptoms
2 = walks slower than peers; 4 = breathless dressing.
CAT ≥ 10 indicates significant symptom impact.
Exacerbations (last 12 months)
Treated with oral steroids or antibiotics, no admission.
Phenotype and BODE
Guides ICS benefit (≥300 favours ICS; <100 against).

Stage

Enter spirometry and symptoms to see stage.

❏ Step 2

What's the plan?

Plan will populate once stage is computed.

Step-up algorithm if exacerbations continue

Step 1Single LABD: LAMA preferred over LABA in COPD without asthma features. Reassess at 6 to 12 weeks.
Step 2LABA + LAMA dual therapy. Single-inhaler combination preferred for adherence.
Step 3Add ICS to make triple if eosinophils ≥ 100 cells/µL AND continued exacerbations, OR if asthma overlap, OR ≥ 1 hospitalisation. Avoid if pneumonia-prone or eosinophils < 100.
Step 4If exacerbations persist on triple: consider azithromycin 250 mg three times weekly (former smokers, eos ≥ 100), refer to respiratory.

Non-pharmacological pillars

Pillar 1Smoking cessation

  • Only intervention shown to alter the slope of FEV1 decline and reduce mortality.
  • Combine behavioural support with NRT, varenicline (Champix), or bupropion. All currently funded in NZ for smokers attempting cessation.
  • Quitline 0800 778 778 and Pathway to Smokefree.

Pillar 2Pulmonary rehabilitation

  • Cochrane evidence: improves CAT by 2 to 5 points, reduces exacerbations and admissions.
  • Refer all symptomatic patients (mMRC ≥ 2) and after any hospitalisation.
  • Available through DHB respiratory services and some community providers.

Pillar 3Vaccinations (NZ)

  • Influenza annually: funded for COPD.
  • Pneumococcal: PCV13 then PPSV23 8 weeks apart, funded for COPD adults ≥ 65 or eligible high-risk groups (per IMAC handbook).
  • COVID-19 boosters per current MoH schedule.
  • Pertussis: Tdap booster every 10 years.
  • RSV: limited availability, consider in severe COPD ≥ 60.

Pillar 4Self-management

  • Written action plan (rescue prednisone and antibiotics for exacerbations in selected patients).
  • Inhaler technique check at every review. Bad technique is the commonest cause of "treatment failure".
  • Review BMI, sarcopenia, anxiety/depression (HADS), advance care planning if FEV1 < 30%.

Refer / red flags

  • Two or more exacerbations per year despite triple therapy.
  • FEV1 < 50% in patients under 65 (consider alpha-1 antitrypsin level).
  • SpO2 < 92% on air at rest (long-term oxygen assessment).
  • Suspected asthma-COPD overlap or atypical features.
  • Significant weight loss, haemoptysis, or new persistent cough (rule out malignancy).
  • Discussion of advance care planning, palliative needs, or non-invasive ventilation.

❏ Step 3

NZ inhaler directory

Filter by class, device, funding, and frequency. Special Authority criteria are summarised on each card; full criteria live on the PHARMAC schedule.

Sources

  1. Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for Prevention, Diagnosis and Management of COPD: 2024 Report. Available from: https://goldcopd.org/2024-gold-report/
  2. Jones PW, Harding G, Berry P, Wiklund I, Chen WH, Kline Leidy N. Development and first validation of the COPD Assessment Test. Eur Respir J. 2009;34(3):648-54.
  3. Best Practice Advocacy Centre New Zealand. COPD: pharmacological management in primary care. BPJ. Available from: https://bpac.org.nz/
  4. McCarthy B, Casey D, Devane D, Murphy K, Murphy E, Lacasse Y. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2015;(2):CD003793.
  5. Celli BR, Cote CG, Marin JM, Casanova C, Montes de Oca M, Mendez RA, et al. The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease. N Engl J Med. 2004;350(10):1005-12.
  6. Pavord ID, Lettis S, Locantore N, Pascoe S, Jones PW, Wedzicha JA, et al. Blood eosinophils and inhaled corticosteroid/long-acting beta-2 agonist efficacy in COPD. Thorax. 2016;71(2):118-25.
  7. PHARMAC Pharmaceutical Schedule. Available from: https://schedule.pharmac.govt.nz/
  8. New Zealand Formulary. Available from: https://nzf.org.nz/
  9. Immunisation Advisory Centre (IMAC). Pneumococcal and influenza recommendations. Available from: https://immune.org.nz/