Table Pharmacologic Treatment of COPD Timing of Therapy Dyspnea without exacerbations *, † Exacerbations with or without dyspnea‡ Initial therapy LAC or LABA LAC or LABA Second-line therapy LABA + LAC or LABA + ICS LABA + LAC or LABA + ICS Third-line therapy LABA + LAC + ICS LABA + LAC + ICS * For persistent dyspnea, consider changing the inhalation device or drug.