COPD Treatment

There are many treatment options for people living with COPD, and we anticipate more options will become available in the next ten years. Here is an overview of the treatment process.

Defining COPD in Spirometry

COPD is defined by post bronchodilator FEV1/FVC ratio<0.7 on spirometry. This helps to differentiate from asthma. A significant bronchodilator response (increase in FEV1>12% and >200cc) can be seen in both COPD and asthma.

Spirometry is indicated if symptoms present (dyspnea, chronic cough/sputum). It should be considered if risk factors are present (smoking, other exposures, asthma history, childhood infections, prematurity, family history), and if one or more comorbidities present; these include but aren’t limited to heart disease, metabolic syndrome, osteoporosis, sleep apnea, depression, lung cancer, premature skin wrinkling.

Each domain may have therapeutic implications.

Spirometry Grades

  • SG 0––Normal spirometry does not rule out emphysema, chronic bronchitis, asthma, or risk of developing either exacerbations or COPD.
  • SG 1 Mild––Post bronchodilator FEV1/FVC ratio<0.7, FEV1>60% predicted.
  • SG 2 Moderate––Post bronchodilator FEV1/FVC ratio<0.7, 30%<fev1<> </fev1<>
  • SG 3 Severe––Post bronchodilator FEV1/FVC ratio<0.7, FEV1<30% predicted.
  • SG U Undefined––FEV1/FVC ratio>0.7, FEV1<80% predicted. This is consistent with restriction, muscle weakness, and other pathologies.

Spirometry Image

Terms to Know

Regular Symptoms––dyspnea at rest or exertion, cough, sputum. Use COPD Assessment Test (CAT) or mMRC Breathlessness Scale to follow course of disease.

Exacerbations––two or more in the past year, especially if FEV1<50% predicted suggests high risk.

Oxygenation––severe hypoxemia: resting O2 sat< 88% or arterial pO2<55 mmHg episodic hypoxemia: exercise or nocturnal desaturation.

Emphysema––reduced density on CT scan, can be localized, abnormal high lung volumes, abnormal low diffusion capacity.

Chronic bronchitis––cough, sputum most days for at least 3 months in at least 2 years.

Comorbidities––defining and treating comorbid conditions, particularly cardiovascular, are critical components of COPD care.

Therapy guided by diagnosis and assessment of severity domains––

  • Each Domain requires separate treatment consideration. For example, if regular symptoms are present, an exercise program needs to be considered regardless of what other domains are present. First line therapy is red. Second line choices are green. The various treatments can generally be combined as needed, but fixed combinations should not be combined with equivalent individual components.
  • Short acting bronchodilators are rescue medications for acute dyspnea. Frequent use suggests the need for addition of a long acting bronchodilator or other adjustments in therapy.
  • Theophylline may be an additional option for some patients potentially improving lung function and symptoms.

These special considerations should be applied to all with COPD:

  • Smoking cessation
  • Vaccinations
  • Alpha-1 testing
  • Exercise

It is also recommended to your monitor patient’s health status with the COPD Assessment Test (CAT) , or the modified Medical Research Council (mMRC) Breathlessness Scale.

To access these documents and additional educational materials please Click Here.

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