Management of COPD

An effective COPD management plan includes four components: (1) assess and
monitor disease; (2) reduce risk factors; (3) manage stable COPD; (4) manage
exacerbations.
The goals of effective COPD management are to:
– Prevent disease progression
– Relieve symptoms
– Improve exercise tolerance
– Improve health status
– Prevent and treat complications
– Prevent and treat exacerbations
– Reduce mortality
Component 1: Assess and
monitor disease

The goals of COPD assessment are to determine the level of airflow limitation, the
impact of disease on the patient’s health status, and the risk of future events (such
as exacerbations, hospital admissions, or death), in order to guide therapy

Spirometrically Assessment of
Assessment of
confirmed symptoms/risk of
airflow limitation
diagnosis exacerbation
Spirometrically confirmed
diagnosis
COPD should be considered in any patient who has dyspnea, chronic cough or
sputum production, and/or a history of exposure to risk factors for the disease.
Spirometry is required to make the diagnosis; the presence of a post-bronchodilator
FEV1/FVC < 0.70 confirms the presence of persistent airflow limitation.
Assessment of airflow limitation
Assessment of symptoms/risk of
exacerbation
Combined COPD assessment
Component 2: Reduce risk
factors

– Smoking cessation
Smoking cessation is the single most effective and cost effective way to reduce
exposure to COPD risk factors. Quitting smoking can prevent or delay the development
of airflow limitation, or reduce its progression, and can have a substantial effect on
subsequent mortality
Nicotine replacement products. Nicotine replacement therapy (nicotine gum, inhaler,
nasal spray, transdermal patch, sublingual tablet, or lozenge) reliably increases long-
term smoking abstinence rates3-5 and is significantly more effective than placebo.
Pharmacological products. Varenicline, bupropion,and nortriptyline have been shown
to increase long-term quit rates
Component 3: Manage stable COPD:
Pharmacological Treatment
 Treatment Of Stable Copd:
Non-pharmacological Treatment
Education and self-management
Physicians and healthcare providers need to go beyond pure education/advice-giving (didactic) approaches to help patients
learn and adopt sustainable self-management skills. In addition to addressing behavioral risk factors (i.e., smoking, diet,
exercise), self-management should involve patients in monitoring and managing the signs and symptoms of their disease,
being adherent to treatment (including to medications and other medical advice), maintaining regular contact with
healthcare providers, and managing the psychosocial consequences of their condition.
Physical activity
There is evidence that physical activity is decreased in COPD patients. This leads to a downward spiral of inactivity which
predisposes patients to reduced quality of life, increased rates of hospitalization and mortality.
Pulmonary rehabilitation programs
The components of pulmonary rehabilitation may vary but evidence-based best practice for program delivery includes:
structured and supervised exercise training, smoking cessation, nutrition counseling, and self-management education.
 Treatment Of Stable Copd:
Non-pharmacological Treatment
Nutritional support
For malnourished patients with COPD nutritional supplementation is recommended
Vaccination
Influenza vaccination is recommended for all patients with COPD.
Pneumococcal vaccinations, PCV13 and PPSV23, are recommended for all patients > 65 years of age. The PPSV23 is also
recommended for younger COPD patients with significant comorbid conditions including chronic heart or lung disease
Oxygen therapy
– Long-term oxygen therapy is indicated for stable patients who have:
• PaO2 at or below 7.3 kPa (55 mmHg) or SaO2 at or below 88%, with or without hypercapnia confirmed twice over a
three-week period; or
• PaO2 between 7.3 kPa (55 mmHg) and 8.0 kPa (60 mmHg), or SaO2 of 88%, if there is evidence of pulmonary
hypertension, peripheral edema suggesting congestive cardiac failure, or polycythemia (hematocrit > 55%).
Ventilatory support
NIV is occasionally used in patients with stable very severe COPD
Treatment Of Stable Copd:
Non-pharmacological Treatment
Component 4: Manage
exacerbations
– COPD exacerbations are defined as an acute worsening of respiratory
symptoms that result in additional therapy.
They are classified as:
• Mild (treated with short acting bronchodilators only, SABDs)
• Moderate (treated with SABDs plus antibiotics and/or oral corticosteroids) or
• Severe (patient requires hospitalization or visits the emergency room). Severe
exacerbations may also be associated with acute respiratory failure.
Treatment setting
The goal for treatment of COPD exacerbations is to minimize the negative impact of
the current exacerbation and to prevent subsequent events.

yes yes
Hospitalization? life-threatening? Intensive care

no no
Pharmacological Management of
theraphy severe but not life
(bronchodilators, threatening (table)
corticosteroids, and
antibiotics +
oxygen,ventilation *)
 Thank you
Source:
GOLD
https://www.who.int/respiratory/copd/man
agement/en/