Chronic obstructive pulmonary disease (COPD)

20-40 mcg (1-2 puffs of 20 mcg/puff) QID - long-term

Not routinely indicated in children

ATROVENT Inhaler CFC-Free 20 micrograms/actuation SmPC section 4.2 (eMC product 61)

Short-acting anticholinergic bronchodilator that blocks muscarinic receptors in airway smooth muscle, relieving bronchospasm and improving airflow in COPD.

18 mcg per capsule (1 capsule inhaled once daily via DPI device) - long-term

Not indicated in children

Spiriva ® 18 microgram, inhalation powder, hard capsule SmPC section 4.2 Posology and method of administration (eMC product 1693)

Long-acting anticholinergic bronchodilator used for maintenance therapy in COPD, giving sustained blockade of airway muscarinic receptors for smoother, longer-lasting symptom control than the short-acting agent.

1 inhalation (50/500 mcg per dose) twice daily - long-term

Not indicated for COPD in children

Seretide Accuhaler 50/500 SmPC section 4.1 Therapeutic indications and 4.2 Posology - COPD (eMC product 5504)

Combination long-acting beta agonist and inhaled corticosteroid; the bronchodilator component relaxes airway smooth muscle while the steroid component reduces airway inflammation, used together in more severe or exacerbation-prone COPD needing combined bronchodilation and anti-inflammatory control.

Chronic Obstructive Pulmonary Disease (COPD) - disease-level clinical article (copd-clinical.txt)

Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.

100-200 mcg (1-2 puffs of 100 mcg/puff) as needed, up to 4 times a day; maximum 8 puffs in 24 hours and not more often than every 4 hours - as-needed, long-term

COPD is not a paediatric condition. Salbutamol is dosed by puffs, not by weight, in any case.

Egyptian National Drug Formulary - Respiratory 2026 (salbutamol monograph)

GOLD says a rescue short-acting bronchodilator goes to every COPD patient; maintenance inhalers do not fill that role. The patient who is breathless walking to the mosque has nothing to reach for without one.

40 mg once daily in the morning x 5 days, then stop - no taper

COPD is not a paediatric condition.

GOLD 2025 Report - Global Strategy for the Diagnosis, Management, and Prevention of COPD, chapter 4 (management of exacerbations)

The exacerbation is what brings the COPD patient to the clinic, and the prescription for it is a steroid and sometimes an antibiotic on top of the inhalers. Neither was in this condition.

100 mg twice daily on day 1, then 100 mg once or twice daily x 5 days

COPD is not a paediatric condition.

Egyptian National Drug Formulary - Antimicrobial 2023 (doxycycline monograph)

The Egyptian Essential Medicine List names exacerbations of COPD as a doxycycline indication, and it is an AWaRe Access antibiotic - the group to reach for first. GOLD names tetracycline among the empirical choices and caps outpatient treatment at 5 days.

Oral: 500 mg in a single loading dose on day 1, followed by 250 mg once daily on days 2 to 5 or 500 mg once daily for 3 days x 3 to 5 days

5-6 mg/kg/day [child max 250 mg]

(Children (general dosing): Oral: 10 to 12 mg/kg once on day 1 (maximum 500 mg/dose), then 5 to 6 mg/kg once daily (maximum 250 mg/dose).)

WATCH group - carries resistance cost. Egyptian EML 2025.

Egyptian National Drug Formulary - Antimicrobial 2023

Alternative first-line macrolide antibiotic for acute bacterial exacerbations of COPD.

500 mg every 8 to 12 hours, or 875 mg every 12 hours x 5 to 7 days

Not applicable - COPD is an adult disease.

Egyptian National Drug Formulary - Antimicrobial 2023 (amoxicillin and clavulanate monograph)

The disease article makes co-amoxiclav one of three first-line antibiotics for an exacerbation with purulent sputum, alongside the doxycycline and azithromycin the card already carried; it is the beta-lactam option, which the card had none of. The ENDF's oral indication list does not name COPD, but its IV list names chronic bronchitis (acute exacerbation) and its oral dosing range is what is written here.

600 mg once daily, or 200 mg three times daily, by mouth; abundant fluid intake supports the mucolytic effect - The formulary leaves duration to the prescriber - assess symptomatic benefit at 4 weeks and stop if there is none

(Adolescents over 12 years: 200 mg three times daily. Adolescents 14 years and over: 600 mg once daily or 200 mg three times daily. Maximum 600 mg/day. Safety and efficacy are not established under 12 years. COPD is not a paediatric condition in any case.)

Egyptian National Drug Formulary - Respiratory 2026 (acetylcysteine monograph)

29 live products, mostly the 600 mg effervescent tablet. The formulary's oral indication is a mucolytic adjuvant in respiratory disorders with thick viscous mucus hypersecretion, which is the chronic productive cough that this condition's three inhalers do nothing for.

500 to 750 mg once daily by mouth or intravenously

ENDF: in pediatric patients, fluoroquinolones are not routinely first-line therapy. COPD is in any case an adult disease.

WATCH group - carries resistance cost. Egyptian EML 2025.

Alternatives. Levofloxacin is named first by the article, and the ENDF's levofloxacin indication list names chronic obstructive pulmonary disease acute exacerbation by name where moxifloxacin's names chronic bronchitis; levofloxacin also has an oral and an IV route in the same monograph.

Egyptian National Drug Formulary - Antimicrobial 2023 (levofloxacin monograph, chronic obstructive pulmonary disease acute exacerbation)

The article escalates to a respiratory fluoroquinolone, naming levofloxacin first, for GOLD 3 to 4 disease, recent hospitalisation or recent antibiotic exposure - it puts this under inpatient management of a moderate to severe exacerbation. The ENDF names that indication in the monograph's own list.

400 mg once daily by mouth or intravenously

ENDF: in pediatric patients, fluoroquinolones are not routinely first-line therapy, and limited dosing data are available. COPD is in any case an adult disease.

WATCH group - carries resistance cost. Egyptian EML 2025.

Egyptian National Drug Formulary - Antimicrobial 2023 (moxifloxacin monograph, acute bacterial exacerbation of chronic bronchitis)

The article's other named respiratory fluoroquinolone for the same escalation. No renal dose adjustment is needed, which is the practical reason to reach for it over levofloxacin.

250 mg once daily, or 500 mg three times weekly, long term

Not applicable - COPD is an adult disease.

WATCH group - carries resistance cost. Egyptian EML 2025.

Chronic Obstructive Pulmonary Disease (COPD) - disease-level clinical article (copd-full.txt)

A different prescription from the card's other azithromycin row, which is the 3 to 5 day course for an acute exacerbation. This one is taken continuously to make exacerbations less frequent in patients having two or more a year despite optimised inhaled therapy. The ENDF doses azithromycin for the acute exacerbation only, so the maintenance figure comes from the disease article, which states drug and dose in one sentence.