Chronic obstructive pulmonary disease (COPD) is a group of chronic lung diseases that block air flow in lungs, such as chronic bronchitis.
Symptoms of COPD
- Wheezing sound with breath
- Shortness of breath, especially on exertion
- Cyanosis of lips and nails
- Chronic cough accompanied by sputum production
- Recurrent lower respiratory tract infections
- Weight loss
Diagnosis of COPD
- Chest X-rays
- CT scans
- Blood oxygen saturation
Patients who are older than 40 years of age and who are current or ex-smokers should undertake spirometry if they answer yes to any one of the following questions:
- Do you cough regularly?
- Do you cough up phlegm regularly?
- Do even simple chores or light exertion make you short of breath?
- Do you wheeze when you exert yourself, or at night?
- Do you get frequent “colds” that persist longer than those of other people you know?
Signs of Severe Exacerbation (any of the following)
- Marked dyspnea and tachypnea (>30 respirations/minute)
- Use of accessory muscles (sternomastoid and abdominal) at rest
- SaO2 < 90%
Indications for Hospital Assessment or Admission
- Marked increase in intensity of symptoms, such as sudden development of resting dyspnea
- Severe underlying COPD
- Onset of new physical signs (e.g., cyanosis, peripheral edema)
- Failure of an exacerbation to respond to initial medical management
- Presence of serious comorbidities (e.g., heart failure or newly occurring arrhythmias)
- Frequent exacerbations
- Older age
- Insufficient home support
- Opioids (oral or parenteral) are effective therapy for the management of refractory dyspnea and should be considered on an individual basis.
- Anxiety and depression accompany dyspnea and should be evaluated and treated accordingly. Benzodiazepines, tricyclic anti-depressants and major tranquilizers may be useful in this context.
- Oxygen and fans blowing air onto the face can relieve breathlessness.
- Fatigue can be improved by self-management education, pulmonary rehabilitation, and mind-body interventions
Management of Acute Exacerbations
- In all patients with an exacerbation referred to hospital, a chest radiograph should be obtained and is useful in excluding alternative diagnoses.
- Sending sputum samples for culture in primary care is not recommended.
- Measuring arterial blood gas tensions should be considered and the inspired oxygen concentration should be recorded.
- Theophylline level should be measured in patients on theophylline therapy at admission to rule out toxicity.
- Spirometric tests are not recommended during an exacerbation of COPD.
Pharmacological Management of an Acute Exacerbation
- Inhaled SABA with or without inhaled SAMA are the preferred bronchodilators for treatment of an exacerbation of COPD.
- Both nebulizers and hand-held inhalers can be used to administer inhaled therapy during exacerbations of COPD.
- Patients should be changed to hand-held inhalers as soon as their condition has stabilized.
- For COPD patients with acute exacerbation, prednisolone 30 mg orally should be administered for 5-10 days. There is no added clinical benefit of duration of systemic corticosteroids beyond 14 days.
- Antibiotics should be used to treat exacerbations of COPD associated with a history of more purulent sputum.
- The length of antibiotic therapy need not exceed 5 days for mild to moderate exacerbations of COPD.
- For moderate to severe exacerbations of COPD, a 7 to 10 day course of antibiotics is recommended.
Non-pharmacological Management of an Acute Exacerbation
- For COPD patients with acute exacerbation, controlled oxygen should be given to keep the blood oxygen saturation, SaO2 within a target saturation of 88 – 92%.
- Clinicians who care for patients with chronic or advanced respiratory diseases should be trained in, and be capable of providing basic palliative care to prevent and relieve suffering by controlling symptoms.
- Clinicians should consult with palliative care specialists as appropriate for managing palliative care situations beyond their level of competence.
Treatment Options for COPD Patients
A list of treatment options are mentioned below (but not limited to):
- Long term oxygen therapy
- Long-term macrolides
- Lung Volume Reduction
- Lung transplantation