COPD treatment: a comprehensive guide

COPD is a set of chronic pulmonary diseases in which the airways are chronically inflamed and constricted (obstructive). Lung disease is progressive and cannot be reversed. COPD cannot be cured and lung damage that has already occurred is irreversible. However, with the right treatment, it is possible to slow down the progression and alleviate COPD symptoms. Early diagnosis and the avoidance of risk factors such as smoking are important.

What causes COPD? In developed countries such as the UK, there is one main cause: tobacco smoking. Over the years, tobacco smoke damages the cilia and mucous membranes of the respiratory tract, accelerating the normal ageing process of the lungs. About 10% of people affected by COPD in the UK have never smoked⁴. So, what are other causes of COPD?

Other risk factors for COPD:

• Passive smoking: Children from smoking households are more likely to develop COPD later in life than people who weren’t exposed to tobacco smoke during childhood.
• Occupational exposure to harmful substances such as dust and fumes.
• Air pollution, be it from road traffic or industrial emissions. Often underestimated: the good old comfy open fire.
• Genetics: e.g. the rare genetic disorder alpha-1-antitrypsin deficiency.
• Infections and chronic bronchitis in childhood: People who suffered from frequent respiratory infections in childhood have an increased risk of developing COPD in old age⁵.

Apart from tobacco smoke, the causes and risk factors of COPD have not been conclusively clarified.

The signs of COPD are:

• Chronic chesty cough with sputum
• Shortness of breath            
• Frequent chest infections

In early stages the symptoms are rather mild, which is why they are not taken seriously at first and are equated with a respiratory infection. There are different stages of chronic obstructive pulmonary disease, which are also known as GOLD stages.

GOLD 1 – mild COPD symptoms:
At this stage, the symptoms are usually so mild that affected people don’t even think about having a chronic lung disease. The cough is rather weak and is limited to the morning hours. However, a cough with sputum is already typical. These symptoms of COPD are often interpreted by those affected as a persistent or recurring infection.

GOLD 2 – moderate COPD
In this stage, the symptoms are usually somewhat more pronounced. The cough with sputum is increasingly frequent throughout the day. Patients may also experience shortness of breath after physical exertion. If patients are physically inactive or avoid physical activity due to breathlessness, they may not even notice this deterioration.

GOLD 3 – severe COPD
Most patients are diagnosed at this stage, as the symptoms of sputum production, coughing and breathlessness are already noticeable during everyday activities. Acute infections and exacerbations occur more frequently. Lung function is already severely impaired at this stage. Everyday life becomes increasingly difficult and the quality of life for patients decreases as a result.

GOLD 4 – very severe COPD
Many of those affected now suffer from breathlessness even at rest and during light everyday activities. They are often no longer able to cope with everyday life on their own and are dependent on help. Some already require an additional oxygen supply at this stage.

An accurate diagnosis of COPD requires a thorough assessment by a specialist. This includes lung function tests, a comprehensive medical history and, in some cases, imaging procedures. The disease is usually diagnosed at a late stage because the symptoms are often only then perceived as a severe limitation. You should consult a doctor if you or a relative over 35 have / has one of the risk factors (especially being a smoker) and one or more of the following symptoms:

• Exertional breathlessness
• Chronic cough
• Regular sputum production
• Frequent recurring bronchitis during the colder season

At the physician’s office you might be asked the following⁶:

• If you suffer from weight loss
• If you have reduced exercise tolerance
• If you wake up breathless during the night
• If you feel fatigue
• Your job history (occupational exposure to fumes / dusts)
• If you suffer from chest pain
• If you are coughing up blood

Being precise with your answers really helps a correct diagnosis and an early treatment.

Drug therapy for COPD

Drug treatment for COPD aims to alleviate or prevent symptoms, reduce the frequency and severity of exacerbations (sudden deteriorations in health) and improve quality of life. Medication is always prescribed by the attending healthcare professional and should not be changed independently. In most cases, medication for COPD is inhaled. This ensures that the medication reaches where it is supposed to work, namely the lungs. Compared to systemic intake (e.g. tablets), a lower dose is required to achieve the desired effect, provided it is inhaled correctly.

Bronchodilators
Bronchodilators are drugs that dilate the bronchial tubes and thus reduce breathlessness. They are part of the basic medication for COPD. This means that almost every COPD patient has them in their treatment plan. Bronchodilators are also important in COPD to reduce the hyperinflation of the lungs that is typical of COPD.

Inhaled Corticosteroids (ICS)
These drugs have an anti-inflammatory effect and are intended to reduce the frequency and severity of exacerbations (sudden exacerbations = deterioration in health). These anti-inflammatory drugs are usually prescribed to patients with frequent exacerbations. If ICS are inhaled via a metered dose inhaler (spray), it is advisable to use an inhalation aid (spacer) to avoid side effects such as fungal infections in the mouth and throat.

Exercise and physical training for COPD
Unfortunately, many people who are affected by the symptoms of COPD (which in the early stages only occur with exercise) react by being inactive instead of visiting the doctor's office.  This avoidance of symptoms through inactivity is an unhealthy vicious circle, as the benefits of exercise in COPD are well known^7,8. Even though exercise is safe, speak to a GP for advice on exercise and physical training with COPD.

Respiratory (physio) therapy
Respiratory therapy aims to relieve breathlessness at rest and during physical exertion. Removing mucus from the bronchial tubes and reducing coughing are further goals. PEP (positive expiratory pressure) therapy can also be used. This involves exhaling against a positive pressure. The PARI PEP S system can be combined with inhalation to save time. Oscillating PEP devices such as the PARI O PEP can also support mucus clearance.

Inhaling isotonic saline with a nebuliser moisturises the mucous membranes and can help prevent respiratory infections by supporting the self-cleaning function of the airways. Preventing respiratory infections is crucial as they can lead to exacerbations. Inhalation of hypertonic saline solution supports mucus clearance in the bronchi.

The best treatment for COPD is prevention. Tobacco smoke is the biggest risk factor for COPD. Stopping smoking is probably the most effective and cost-effective measure to prevent COPD or slow down the progression of the disease. The NHS offers a service on their website where you can find stop smoking support services in England, Scotland, Wales and Northern Ireland. If you are from Ireland you can also find services to quit smoking online.

Chronic Obstructive Pulmonary Disease (COPD) is an incurable, progressive lung condition. Early detection and treatment can slow down its progression, yet diagnosis often occurs in advanced stages. Persistent symptoms such as coughing, sputum production and breathlessness warrant immediate consultation with a healthcare professional, especially for smokers. COPD management focuses on symptom relief and quality of life enhancement. It encompasses pharmacotherapy, smoking cessation, and targeted exercise. Additionally, nebulising saline and medication may help avert respiratory infections, complementing COPD therapy.