By Dr Scott Claxton
This post first appeared in Medical Forum (September 2022) and has been edited.
Understanding COPD
COPD is a common lung disease responsible for significant disability. It is a common cause of hospitalisation and death. In Australia it is under diagnosed and often over or even undertreated. Primarily a lung disease, it has extrapulmonary manifestations and is frequently associated with respiratory and non-respiratory comorbidities all of which can influence symptoms and outcomes.
Assessment:
- Spirometry: Essential for diagnosing COPD, spirometry measures airflow limitation. A post-bronchodilator FEV1/FVC ratio of less than 0.7 indicates irreversible airflow limitation, suggesting COPD, particularly with a history of significant smoking or exposure to pollutants.
- Chest Radiology: While not diagnostic of COPD alone, chest X-rays or CT scans are useful for identifying coexisting conditions such as emphysema or bronchiectasis.
- Extra-Pulmonary Disease: Screening for comorbidities (e.g., cardiovascular disease, osteoporosis) may be warranted based on clinical symptoms.
- Smoking Cessation: The most crucial intervention for managing COPD and slowing disease progression.
- Symptom Severity Assessment: The degree of airflow limitation does not always correlate with symptom severity. Assessing COPD severity involves evaluating symptoms through tools like the modified Medical Research Council (mMRC) scale, the COPD Assessment Test (CAT), and the frequency of exacerbations.
Treatment Strategies:
- Pharmacological Therapy:
- Bronchodilators: Essential for managing symptoms. Patients typically start with either a long-acting beta agonist (LABA) or a long-acting muscarinic antagonist (LAMA). Dual therapy (LABA/LAMA) may be necessary if symptoms persist.
- Inhaled Corticosteroids (ICS): Limited role in initial management; generally reserved for patients with frequent exacerbations despite dual bronchodilator therapy. Long-term use can lead to side effects, necessitating careful risk-benefit assessment.
- Non-Pharmacological Interventions:
- Patient Education: Crucial for understanding COPD and treatment plans.
- Vaccinations: Up-to-date flu, pneumococcal, and COVID vaccinations can reduce exacerbation risks.
- Exercise: Integral for maintaining fitness and weight, often facilitated through pulmonary rehabilitation programs.
- Asthma-COPD Overlap: Requires specialised assessment if symptoms or history suggest both conditions. Diagnosis may involve identifying asthma features and assessing bronchodilator response.
Overall Approach:
Tailoring therapy to individual symptoms and needs helps in avoiding undertreatment or overtreatment. Effective management involves a combination of medication, lifestyle modifications, and addressing comorbidities to improve overall patient outcomes and quality of life.