Running head : Chronic Obstructive Pulmonary Disease 1

Chronic Obstructive pulmonary Disease

Peter Kimani

Saint Paul University

Authors note

My name is Peter Kimani, and I am based in Nairobi. I am passionate about health issues,

particularly those affecting marginalized communities. I would like to express my gratitude to

Edwin Kimani for his support and guidance throughout the writing process. For any further

inquiries or collaborations, please feel free to contact me at 0745049127.

Chronic Obstructive Pulmonary Disease 2

Abstract

Chronic Obstructive Pulmonary Disease (COPD) is a pressing health concern in Liverpool,

identified as a hotspot with high prevalence and mortality rates, particularly among heroin
smokers. Past studies recommend integrating community COPD services to enhance population
well-being, yet public investment in COPD research remains minimal. The NHS offers various
treatments for COPD, focusing on symptom management and lung damage prevention; however,
for non-responsive cases, tiotropium monotherapy is proposed as an additional intervention,
despite lacking NICE or NHS approval. This drug shows promise in hindering obstructive lung
disease progression, highlighting the need for innovative approaches to combat COPD in
Liverpool.

Keywords: COPD, Liverpool, tiotropium monotherapy.

Chronic Obstructive Pulmonary Disease 3

Chronic Obstructive Pulmonary Disease

The condition that will be discussed is Chronic Obstructive Pulmonary Disease (COPD)

which has been prevalent in Liverpool. Past studies have looked at Liverpool and identified it as

a hotspot for COPD. In particular, Nightingale et al. (2020), conducted a research of COPD in

people that smoked heroin. In their findings, they mention that Liverpool warrants efforts to

integrate community COPD services to better the wellbeing of the population. Additionally,

Liverpool has been found to have high cases or mortality due to COPD.

According to reports of the UK hotspots with highest emergency admissions and death

rates for lung conditions, individuals in Liverpool are among the most at risk of death and

admission due to lung conditions. Also, it was found that areas like Liverpool contribute more

that half of the areas ranked highest in emergency admissions and mortality rate in the UK

(Wood 2017). Besides, lung conditions in the UK are among the conditions that have a high

mortality rate. Wood, S. (2017) mentions that only 2% of public investment has been dedicated

to research on the problem. Therefore, the risks of deaths and the high prevalence pushes the

study to focus on Liverpool to help combat the problem.

Alternative Interventions

The NHS warns people that there is no cure for COPD, but provides treatment options

that can be used by the patients having the condition. The treatments include stopping smoking,

inhalers and tablets to improve breathing, a pulmonary rehabilitation, and surgery or lung

transplant (NHS 2023). The costs varies for each treatment, but all have one goal. When patients

are recommended to stop smoking, it does not reverse the damage that had already occurred but

prevent further damage to the lungs. The inhalers are also encouraged for COPD patients that
Chronic Obstructive Pulmonary Disease 4

have developed breathing problems. Most of the patients are given short-acting bronchodilator,

but if they experience more symptoms regularly, long acting inhalers will be given. However, if

the long inhalers fail to act, steroid inhalers are provided to the patient (NHS 2023).

There are patients who do not respond to inhalers as they symptoms still continue to

affect them. In such a scenario, tablets are issued like theophylline tablets, mucolytic, antibiotics,

and steroid tablets. In other recommendations, doctors might propose pulmonary rehabilitation.

The program included in the rehabilitation includes physical exercise, diet change, education

about the condition, and psychologic support (NHS 2023). There are other treatments that are

recommended by the NHS but the main are discussed above.

The proposed intervention that will used in addition to the therapies and medicines for

COPD in the UK is tiotropium monotherapy. Currently the drug is being researched on its

significance and side effects but has not been approved by NICE or NHS. The US has approved

it due to the significance that the medicine has done to the COPD patients. In clinical trials, the

drug was found to prevent the spread of obstructive lung disease and its complications to the

patient. The FDA also discourage its use for children below 16 years and encourage the

combination of tiotropium and olodaterol therapy (Delgado and Bajaj 2019). The drug will

impact the progression of the condition leading to improvement of life for patients. In order to

implement the usage of the drug, I will involve NICE and provide evidence showing the benefit

patients have gained from the drug. In Anzueto and Miravitlles, (2020) report, tiotropium

monotherapy was used in China to patients with COPD and the findings showed that the

medicine was effective as a long term treatment.

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References

Anzueto, A. and Miravitlles, M., 2020. Tiotropium in chronic obstructive pulmonary disease–a

review of clinical development. Respiratory research, 21(1), pp.1-16.

https://doi.org/10.1186%2Fs12931-020-01407-y

Delgado, B.J. and Bajaj, T., 2019. Tiotropium. Statpearls.

NHS. (2023) Treatment of Chronic Obstructive Pulmonary Disease, NHS choices. Available at:

https://www.nhs.uk/conditions/chronic-obstructive-pulmonary-disease-copd/treatment/

(Accessed: 24 December 2023).

Nightingale, R., Griffiths, P., Mortimer, K., Walker, P., Byrne, T., Marwood, K., Morrison-

Griffiths, S., Renwick, S., Rylance, J. and Burhan, H., 2020. Exploring perspectives on

chronic obstructive pulmonary disease in people who smoke heroin: a qualitative

study. BJGP open, 4(3).https://pubmed.ncbi.nlm.nih.gov/32665233/

RxList (2020) Spiriva (Tiotropium bromide): Uses, dosage, side effects, interactions, warning,

RxList. Available at: https://www.rxlist.com/spiriva-drug.htm (Accessed: 24 December

2023).

Wood, S. (2017) Liverpool programme leads the way in lung cancer treatment - university of

liverpool news, News. Available at: https://news.liverpool.ac.uk/2017/06/21/liverpool-

programme-leads-the-way-in-treatment-of-lung-cancer/ (Accessed: 24 December 2023)