Chronic Obstructive Pulmonary Disease (COPD)

Investigations

• CBC : ↑ RBCs, anemia ?
• CXR: Hyperinflation
• CT: only if CXR/spirometry abnormalities require clarification
• ECG: Right atrial and ventricular hypertrophy (cor pulmonale)
• echo
• ABG: if O₂ ≤92%; ↓ PₐO₂ ± hypercapia
• Spirometry (FEV₁ <80% of predicted, FEV₁:FVC ratio <70% post-​bronchodilation, ↑ TLC, ↑ RV, ↓ DLCO in emphysema)
• Thyroid function test (TFT)
• α1-​AT levels

Treatment

• Smoking cessation

• Encourage exercise

• Diet advice ± supplements

• Mucolytics

• Screen for depression

• Diuretics if Edema

• Flu and pneumococcal Vaccinations

• Start by short-acting β₂-agonist (SABA) or short-acting muscarinic antagonist (SAMA)

• If no optimal response but FEV₁ >50%

  • Use Long-acting β₂-agonist (LABA) or Long-acting muscarinic antagonist (LAMA)
  • If on LABA and no optimal response move to LABA + inhaled corticosteroid (ICS)
  • If no optimal response or was on LAMA then move to LAMA plus LABA/ICS combination inhaler

• If no optimal response but FEV₁ <50%

  • use LABA plus inhaled corticosteroid (ICS) in combined inhaler or Long-acting muscarinic antagonist (LAMA)
  • If no optimal response move to LAMA plus LABA/ICS combination inhaler

• Long-term O₂ therapy if

• Clinically stable non-smokers with PₐO₂ <7.3 kPa (≈ 55 mmHg)—despite maximal treatment. These values should be stable on two occasions >3wks apart.

• If PₐO₂ 7.3–8.0 kPa (≈ 55–60 mmHg) and pulmonary hypertension (eg RVH; loud S2), or polycythaemia, or peripheral oedema, or nocturnal hypoxia

• O₂ can also be prescribed for terminally ill patients.