How should I manage a patient with newly diagnosed COPD in terms of pharmacological treatment and lifestyle advice?

For a patient with newly diagnosed COPD, begin by explaining the condition and its symptoms to the patient. ¹

Advise and encourage smoking cessation at every opportunity, offering help such as nicotine replacement therapy, varenicline, or bupropion, combined with support programmes. ¹

Recommend avoiding passive smoke exposure. ¹

Manage breathlessness initially with short-acting bronchodilators, such as SABA or SAMA, used as necessary. ¹

Offer inhaled therapy based on symptom severity and exacerbation risk, starting with a long-acting bronchodilator (LABA or LAMA), preferably a long-acting agent if appropriate. ¹

For patients with persistent symptoms or exacerbations, escalate treatment to a combination of LABA and LAMA, and consider adding inhaled corticosteroids (ICS) if blood eosinophil count exceeds 300 cells/microlitre. ¹,²

Advise vaccination against influenza and pneumococcus to reduce respiratory infections. ¹

Encourage participation in pulmonary rehabilitation to improve symptoms, exercise tolerance, and quality of life. ¹

Discuss the importance of medication adherence and correct inhaler technique. ¹

Provide lifestyle advice on increasing physical activity, diet, and avoiding air pollution. ¹

Develop a personalized self-management and exacerbation action plan, including when to use short courses of oral corticosteroids and antibiotics for exacerbations. ¹