Heterogenous lung condition characterised by chronic respiratory symptoms (dyspnea, cough, sputum production and/or exacerbations) due to abnormalities of the airways and/or alveoli that cause persistent and often progressive airflow obstruction
Characterised by airway obstruction (FEV1 <80% predicted; FEV1/FVC <0.7)
Stable phase COPD treatment
Goals of therapy
The two main goals of therapy are:
To provide symptomatic relief (reduce respiratory symptoms, improve exercise tolerance, improve health status)
Reduce future risk (prevent disease progression, prevent and treat exacerbations, and reduce mortality).
Only three interventions—smoking cessation, oxygen therapy in chronically hypoxemic patients, and lung volume reduction surgery in selected patients with emphysema have been demonstrated to improve survival of patients with COPD
Pharmacotherapy
Bronchodilators- inhaled route is preferred
In symptomatic patients, both regularly scheduled use of long-acting agents and as-needed short-acting medications are indicated.
Short acting anticholinergics (ipratropium bromide)
Long acting anticholinergics (glycopyronium)
Beta agonists- short-acting beta agonists ease symptoms with acute improvements in lung function (salbutamol)
Long acting provide symptomatic benefit:
Arformoterol, formoterol, indacaterol
Inhaled corticosteroids- help to reduce exacerbations
Oxygen therapy-supplemental O2 is the only pharmacologic therapy demonstrated to unequivocally decrease mortality rates in patients with COPD
Methylxanthines
PDE4 inhibitors- roflumilast has been demonstrated to reduce exacerbation frequency in patients with severe COPD, chronic bronchitis, and a prior history of exacerbations
Non-pharmacologic therapy
Pulmonary rehabilitation- comprehensive treatment program that incorporates exercise, education, and psychosocial and nutritional counseling
Lung volume reduction surgery (LVRS)- surgery to remove the most emphysematous portions of lung improves exercise, lung function, and survival
Lung transplantation- candidates for lung transplantation should:
Have very severe airflow limitation
Severe disability despite maximal medical therapy
Be free of significant comorbid conditions such as liver, renal, or cardiac disease
Modified medical research council questionnaire
COPD assessment test
Read the full note free
The whole note, all 10 sections, is free with an AceMed account, with its 15 flashcards. Premium adds flashcard recall, highlights and Ask AI.
