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Posted: September 10th, 2023
Management of COPD
COPD, or chronic obstructive pulmonary disease, is a condition that affects the lungs and causes persistent respiratory symptoms and airflow limitation. COPD can have a significant impact on the quality of life and well-being of people who have it. However, there are various treatment options available to manage COPD and reduce its complications.
One of the main goals of pharmacological treatment for COPD is to control symptoms such as dyspnea (shortness of breath), cough, and sputum production. Another goal is to prevent or reduce exacerbations, which are episodes of worsening symptoms that may require hospitalization. The most commonly used medications for COPD are bronchodilators, which relax the muscles around the airways and make breathing easier. There are two types of bronchodilators: long-acting beta agonists (LABAs) and long-acting muscarinic antagonists (LAMAs). These medications can be used alone or in combination, depending on the severity and frequency of symptoms. According to the American Thoracic Society (ATS) guidelines, combination therapy with a LABA and a LAMA is recommended over monotherapy with either agent for symptomatic COPD, as it reduces exacerbations and hospitalizations and improves dyspnea . Another type of medication that can be added to LABA/LAMA therapy is an inhaled corticosteroid (ICS), which reduces inflammation in the lungs. Adding an ICS can further reduce exacerbations, but it also increases the risk of pneumonia and should be used with caution . The ATS recommends discontinuing ICS use for patients who have had no exacerbations in the past year . Oral corticosteroids are not recommended for maintenance therapy, as they do not improve outcomes and have significant side effects .
Besides medications, there are other non-pharmacological treatments that can help people with COPD manage their condition and improve their quality of life. Some of these treatments include:
– Smoking cessation: Quitting smoking is the most important step in any treatment plan for COPD, as it can prevent further damage to the lungs and slow down the progression of the disease. Smoking cessation can also reduce the risk of other diseases such as cardiovascular disease and lung cancer . There are various methods and resources available to help people quit smoking, such as nicotine replacement products, medications, counseling, and support groups .
– Pulmonary rehabilitation: Pulmonary rehabilitation is a comprehensive program that involves education, exercise training, nutritional counseling, psychosocial support, and self-management skills for people with COPD . Pulmonary rehabilitation can improve physical function, exercise capacity, dyspnea, fatigue, anxiety, depression, and health-related quality of life in people with COPD . Pulmonary rehabilitation can also reduce exacerbations and hospitalizations .
– Oxygen therapy: Oxygen therapy is the administration of supplemental oxygen to people with COPD who have low blood oxygen levels (hypoxemia). Oxygen therapy can improve survival, exercise tolerance, cognitive function, and quality of life in people with COPD who have severe hypoxemia . Oxygen therapy can be delivered through various devices such as nasal cannulae, face masks, or portable oxygen concentrators .
– Lung surgery: Lung surgery is an option for some people with COPD who have severe emphysema (a type of COPD that causes destruction of the lung tissue) and who do not respond well to other treatments. Lung surgery can involve removing parts of the damaged lung (lung volume reduction surgery) or replacing the entire lung with a donor organ (lung transplantation) . Lung surgery can improve lung function, exercise capacity, dyspnea, and quality of life in selected patients with COPD . However, lung surgery also has risks such as bleeding, infection, rejection, and mortality .
COPD is a chronic condition that affects the lungs and causes respiratory symptoms and airflow limitation. There are various treatment options available to manage COPD and reduce its complications. These options include pharmacological treatments such as bronchodilators and corticosteroids; non-pharmacological treatments such as smoking cessation, pulmonary rehabilitation, oxygen therapy, and lung surgery; and a combination of both. The choice of treatment depends on the individual needs and preferences of each patient with COPD.
 Criner GJ et al. Pharmacologic Management of Chronic Obstructive Pulmonary Disease: An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med 2020; 202(4): e56-e69.
 COPD – Diagnosis and treatment – Mayo Clinic. Available from: https://www.mayoclinic.org/diseases-conditions/copd/diagnosis-treatment/drc-20353685
 Spruit MA et al. An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med 2013; 188(8): e13-e64.
 Shigemura N et al. Lung transplantation for chronic obstructive pulmonary disease. J Thorac Dis 2018; 10(1): 462-469.
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