ONE in 13 Australians over the age of 40 are estimated to be living with COPD . 1 COPD is one of the ‘ big five ’ lung diseases . It is a preventable chronic lung disease and the fifth leading cause of mortality in Australia . It carries a significant burden on the patient ’ s quality of life and the healthcare system . Tobacco smoking , household and ambient air pollution , occupational exposures , chronic asthma and abnormal lung development are major risk factors . 2 The national COPD-X guidelines — written by a multidisciplinary group of clinicians working with Lung Foundation Australia — inform on evidence-based practice for COPD diagnosis and management . 3 Confirming diagnosis
A high index of suspicion for COPD is warranted
in individuals with respiratory symptoms ( breathlessness , cough or sputum production , chest infections ) and risk factors . Together with a detailed history , examination and investigations to
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exclude other causes , the diagnosis of COPD requires spirometry to demonstrate non-reversible airflow obstruction : defined as a ratio of post-bronchodilator FEV1 to forced vital capacity ( FVC ) below the lower limit of normal .
Optimising function
The mainstay of non-pharmacological
therapy is pulmonary rehabilitation . This improves quality of life and exercise capacity and reduces exacerbations . Additional benefits include reversing deconditioning and skeletal muscle dysfunction and improving cardiovascular risk and mental health . 4 A referral for pulmonary rehabilitation can be provided either after a recent hospital admission for COPD or during ambulatory care reviews for symptomatic patients . In the era of COVID-19 , telerehabilitation is also an effective delivery method to educate and empower individuals and meet physical activity guidelines while improving accessibility .
Pharmacological therapy consists of
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inhaled medicines prescribed in a stepwise fashion . Regular long-acting bronchodilators ( either monotherapy or combination ) reduce symptoms and exacerbations , while short-acting bronchodilators ( eg , salbutamol ) as required provide immediate symptom relief . In individuals with at least one exacerbation a year , triple therapy with a combination of an inhaled corticosteroid ( ICS ), long-acting muscarinic antagonists ( LAMA ) and LABA has been shown to be beneficial . 1 Instructions for inhaler technique and adherence are important at initiation and regular reviews .
Common multi-morbidities of COPD — cardiovascular disease , osteoporosis , anxiety and depression , obstructive sleep apnoea and bronchiectasis — should be actively identified and managed in conjunction .
Preventing deterioration
Tobacco smoking remains the most significant
risk factor for COPD development in high-income countries , and smoking cessation reduces mortality . Smoking cessation
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counselling should be provided by all healthcare professionals at each appointment for patients who smoke as this increases quit rates . Counselling can be summarised as the 5-A strategy of ask , assess , advise , assist and arrange follow-up . 5 Even in time-poor situations , brief advice to quit and a referral to Quitline have been shown to be effective interventions . The most effective pharmacological therapies include combination nicotine replacement therapy ( long and short acting ) and varenicline . 1
Ensuring up-to-date vaccination status ( for COVID-19 , age-appropriate pneumococcal and annual influenza ) is another prevention strategy . Long-term oxygen therapy improves survival in individuals with demonstrated severe resting hypoxaemia who are not current smokers . 5
Advanced life planning and early consideration of palliative care referrals should be sought for symptom control in progressive disease . Encourage ongoing open discussions regarding advanced health planning and the timing of transition to end-of-life
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