Inflammation-based algorithm
| Component | Management |
|---|---|
| Airway inflammation | |
| Eosinophilic (sputum eosinophil count %>3) | ICS 500 μg twice daily (beclomethasome equivalent) and prednisolone according to Siva23 |
| Neutrophilic (sputum neutrophil count %>61) | Azithromycin 250 mg daily for 3 months |
| Mucus hypersecretion | Positive expiratory pressure device (Acapella) Hypertonic saline 6% twice daily, nebulised |
| Systemic inflammation (CRP >3 mg/litre) | Simvastatin 20 mg daily for 3 months |
If systemic inflammation and neutrophilic airway inflammation were present doxycycline was used in place of azithromycin to avoid coadministration of simvastatin and azithromycin.
CRP, C-reactive protein; ICS, inhaled corticosteroid.