COPD

Question 1

What is chronic obstructive pulmonary disease (COPD)?
COPD is a largely preventable and treatable disease characterized by persistent respiratory symptoms and airflow limitation that is usually progressive and not fully reversible.

Question 2

What are the symptoms of COPD?
Symptoms of COPD include dyspnoea, wheeze, chronic cough, and regular sputum production.

Question 3

What is the main risk factor for developing COPD?
Tobacco smoking is the main risk factor for developing COPD.

Question 4

What is asthma-COPD overlap syndrome (ACOS)?
ACOS is characterized by persistent airflow limitation that displays features of both asthma and COPD.

Question 5

What is the primary aim of treatment for COPD?
The primary aim of treatment is to reduce symptoms and exacerbations and improve quality of life.

Question 6

What non-drug treatments are recommended for COPD patients?
Non-drug treatments include smoking cessation, pulmonary rehabilitation, active cycle of breathing techniques, positive expiratory pressure devices, dietetic input, and interventional procedures.

Question 7

What drug classes are used to treat COPD?
Bronchodilators and inhaled corticosteroids are drug classes used to treat COPD. Examples of bronchodilators include salmeterol (brand name: Serevent) and tiotropium (brand name: Spiriva).

Question 8

What is cor pulmonale?
Cor pulmonale is a complication of COPD that refers to right-sided heart failure caused by pulmonary hypertension.

Question 9

Who should receive pulmonary rehabilitation?
Pulmonary rehabilitation should be offered to appropriate patients, including those who view themselves as being functionally disabled by COPD.

Question 10

What vaccinations should COPD patients receive?
COPD patients should receive the pneumococcal vaccine, annual influenza vaccine, and COVID-19 vaccine.

Question 11

What should the choice of inhaler device be based on in COPD patients?
The choice of inhaler device should be based on the patient’s preference and ability to use the inhaler.

Question 12

What should be done when prescribing an inhaler to a COPD patient?
When prescribing an inhaler, patients should be trained on how to use the device and be able to demonstrate satisfactory inhaler technique, and continue to have their inhaler technique regularly assessed.

Question 13

When should nebulised treatment be considered in COPD patients?
Nebulised treatment should be considered for patients with distressing or disabling breathlessness despite maximal use of inhalers, and continued if an improvement is seen in symptoms, ability to undertake activities of daily living, exercise capacity, or lung function.

Question 14

What initial empirical treatment should be offered to all COPD patients?
For initial empirical treatment, offer a short-acting bronchodilator as required to relieve breathlessness and exercise limitation. This can either be a short-acting beta2 agonist (SABA) such as Salbutamol (brand name: Ventolin) or Terbutaline (brand name: Bricanyl), or a short-acting muscarinic antagonist (SAMA) such as Ipratropium (brand name: Atrovent) or Oxitropium (brand name: Oxivent).

Question 15

What should be ensured before considering step-up treatment options for COPD patients?
Before considering step-up treatment options, ensure that COPD is confirmed spirometrically, relevant vaccinations are given, non-drug treatment options have been optimized including smoking cessation, and that a short-acting bronchodilator is being used.

Question 16

What is the step-up treatment for COPD patients without asthmatic features or features suggesting steroid responsiveness?
In patients who continue to be breathless or have exacerbations, offer a long-acting beta2 agonist (LABA) such as Salmeterol (brand name: Serevent) and a long-acting muscarinic antagonist (LAMA) such as Tiotropium (brand name: Spiriva).

Question 17

When should an inhaled corticosteroid (ICS) be considered in COPD patients on LAMA and LABA therapy?
In patients on a LAMA and LABA who have a severe exacerbation or at least two moderate exacerbations within a year, consider the addition of an ICS such as Fluticasone propionate (brand name: Flixotide) - triple therapy.

Question 18

What should be done if an ICS is given to COPD patients on LAMA and LABA therapy?
If an ICS is given, review at least annually and document the reason for continuation.

Question 19

When should the addition of an ICS be trialed in COPD patients on LAMA and LABA therapy?
In patients on a LAMA and LABA whose day-to-day symptoms continue to adversely impact their quality of life, consider trialling the addition of an ICS such as Budesonide (brand name: Pulmicort) for 3 months.

Question 20

Can treatment with a short-acting beta2 agonist (SABA) be continued in all stages of COPD?
Yes, treatment with a SABA as required may be continued in all stages of COPD.

Question 21

What is the step-up treatment for COPD patients with asthmatic features or features suggesting steroid responsiveness?
In patients who continue to be breathless or have exacerbations, consider treatment with a long-acting beta2 agonist (LABA) such as Salmeterol (brand name: Serevent) which belongs to the LABA drug class, and an inhaled corticosteroid (ICS) such as Fluticasone propionate (brand name: Flixotide) which belongs to the ICS drug class.

Question 22

When should an LAMA be added to the treatment of COPD patients on LABA and ICS therapy?
In patients on a LABA and ICS who have a severe exacerbation or at least two moderate exacerbations within a year, or who continue to have day-to-day symptoms adversely impacting their quality of life, add a long-acting muscarinic antagonist (LAMA) such as Tiotropium (brand name: Spiriva) which belongs to the LAMA drug class - triple therapy.

Question 23

Should SAMA treatment be continued in patients receiving LAMA therapy?
No, discontinue SAMA treatment if a LAMA is given.

Question 24

Can treatment with a SABA be continued in all stages of COPD?
Yes, treatment with a SABA as required may be continued in all stages of COPD.

Question 25

What are examples of drugs used in combination therapy for COPD?
Examples of drugs used in combination therapy for COPD include Fluticasone furoate/vilanterol (brand name: Relvar Ellipta) which combines an ICS and a LABA, Fluticasone furoate/umeclidinium/vilanterol (brand name: Trelegy Ellipta) which combines an ICS, a LAMA, and a LABA, and Budesonide/formoterol (brand name: Symbicort) which combines an ICS and a LABA.