Management of Chronic Obstructive Pulmonary Disease (COPD) involves adjusting treatment based on symptoms and exacerbations NICE CKS. A diagnosis of COPD is suspected in individuals over 35 with a risk factor (typically smoking) and symptoms such as exertional breathlessness, chronic cough, regular sputum production, frequent winter 'bronchitis', or wheeze NICE NG115. The Medical Research Council (MRC) dyspnoea scale should be used to grade breathlessness NICE NG115. Spirometry is performed at diagnosis, to reconsider the diagnosis if there is a good response to treatment, and to monitor disease progression NICE NG115. Post-bronchodilator spirometry is used to confirm the diagnosis NICE NG115.
Self-management plans should be developed collaboratively, covering COPD and its symptoms, non-pharmacological measures (diet, physical activity, pulmonary rehabilitation, smoking cessation, avoiding passive smoking), vaccinations, appropriate use of inhaled therapies, and early recognition and management of exacerbations NICE CKS. This includes advice on adjusting short-acting bronchodilator therapy and when to use prescribed oral corticosteroids and antibiotics for exacerbations NICE CKS. People with COPD should be advised that continued smoking, passive smoke exposure, infections, air pollution, lack of physical activity, and seasonal variations increase their risk of exacerbations NICE NG115.
Pulmonary rehabilitation should be made available to all appropriate individuals with COPD, including those recently hospitalised for an exacerbation, and offered to those who feel functionally disabled by the condition (MRC grade 3 and above) NICE NG115. Rehabilitation programmes should be tailored, multidisciplinary, and include physical training, disease education, and nutritional, psychological, and behavioural interventions NICE NG115.
Pneumococcal and annual flu vaccinations should be offered to all individuals with COPD NICE NG115. Azithromycin may be indicated for symptomatic individuals with frequent severe exacerbations and sputum production, after non-pharmacological and inhaled therapies have been optimised, with further assessment including sputum culture and CT thorax prior to initiation NICE CKS. Roflumilast is an option for severe COPD (FEV1 < 50% predicted) with two or more exacerbations in the previous 12 months despite triple inhaled therapy, and should be initiated by a respiratory specialist NICE CKS.
Referral to a respiratory specialist is indicated if lung cancer is suspected, there is diagnostic uncertainty (e.g., difficulty distinguishing from asthma, disproportionate symptoms to spirometry, very severe or rapidly worsening COPD, suspected cor pulmonale), or if the individual is under 40 with a family history of alpha-1-antitrypsin deficiency NICE CKS. Referral may also be required for oxygen therapy, long-term non-invasive ventilation, nebulizer therapy, long-term oral corticosteroids, or lung surgery NICE CKS. Optimal COPD treatment, including smoking cessation advice, should be provided for cor pulmonale caused by COPD NICE NG115. Oedema associated with cor pulmonale can usually be managed with diuretic therapy NICE NG115.