Treatment of COPD

• Aims of COPD?

  • Reduce symptoms
  • Reduce exacerbations (flare ups)
  • Increase energy
  • Make activities of daily living easier
• COPD Treatment

  • Smoking Cessation
  • Pharmacological therapy–Bronchodilators, Corticosteroids, Oxygen,
  • Non-Pharmacological therapy–Self care, Pulmonary rehabilitation, Surgery, Dietary, NIV – usually BiPAP (Acute exacerbations), End of Life Planning
• Nicotine replacement therapy (NRT)

  • Skin patches
  • Chewing gum
  • Tablets, strips and lozenges
  • Nasal spray
  • Mouth spray
  • Electronic cigarettes
• Side effects of NRT?

  • skin irritation when using patches
  • irritation of nose, throat or eyes when using a nasal spray
  • disturbed sleep, sometimes with vivid dreams
  • upset stomach
  • dizziness
  • headaches 
• Bronchodilators?

  • Act to relax smooth muscles around the bronchioles - Maximize bronchodilation, Allow easier airflow
  • Two main groups used in COPD:
  • Beta2-agonist – inhaled
  • Antimuscarinics – inhaled
  • Can be long or short acting
• Corticosteroids?

  • Used to reduce inflammation in COPD
  • Greater risk of pneumonia
  • Recommended to patients with more severe disease
  • Given in combination with beta 2 agonists or anticholinergic drugs
• Inhaled therapy

  SABA – short acting β2 agonist

  LABA – long acting β2 agonist

  SAMA – short acting antimuscarinic agent

  LAMA – long acting antimuscarinic agent
• Type 1 respiratory failure?


  Failure of oxygenation

  • Ventilation/Perfusion mismatch
  • Shunt
  • Diffusion impairment
  • Alveolar hypoventilation
• Type 2 respiratory failure 


  Failure of ventilation

  • Failure of respiratory muscles, increased work of breathing or control of respiration
  • Increased production of CO2
  • Increased dead space
  • Shunt
• Non-pharmacological therapy

  • Self care
  • Pulmonary rehabilitation
  • Surgery
  • Dietary
  • BiPAP (Acute exacerbations)
  • End of Life Planning
• Treatment - surgery

  • Lung Volume Reduction Surgery (LVRS)
  • Bullectomy
  • Lobectomy
  • Pneumonectomy
  • Transplant
• What can be done to improve management of COPD?

  • Accurate early diagnosis
  • Smoking Cessation
  • Vaccinations
  • Inhaler Technique
  • Functionality and symptom assessment
  • Improving self management skills
  • Education
  • Appropriate Referrals