Comprehensive COPD care: spirometry-based diagnosis, GOLD ABE grouping and inhaler-plus-rehabilitation treatment planning.
Indication
- Chronic cough and shortness of breath in patients over 40 with smoking or occupational exposure
- Post-bronchodilator FEV1/FVC < 0.70 on spirometry
- Recurrent lung infections and sputum production
- Marked decrease in exercise tolerance
- Review of treatment efficacy in patients with established COPD
- Patients with frequent exacerbations (2 or more per year)
- Need for pulmonary rehabilitation
Preparation
- Bring current medication list and information about inhaler use
- Smoking history (pack-years) and occupational exposure history
- Short-term discontinuation of bronchodilators before spirometry as advised by the physician
- Bring any recent chest X-ray or CT images if available
How it's performed
- A detailed respiratory examination and symptom scoring (mMRC, CAT) are performed
- Spirometry with bronchodilator reversibility testing is conducted
- Exacerbation frequency, symptom burden and comorbidities are evaluated
- Risk classification is made according to GOLD groups A, B and E (formerly merged C-D)
- Smoking cessation support and vaccinations (influenza, pneumococcal, COVID-19) are planned
- Bronchodilators (LABA, LAMA), ICS, combination inhalers and pulmonary rehabilitation are recommended as needed
Post-procedure
- Follow-up visit within 4-6 weeks to check inhaler technique
- Clinical evaluation every 3-6 months in stable patients
- Annual spirometry to monitor disease progression
- Follow-up within 2-4 weeks after an exacerbation
- Assessment for long-term oxygen therapy and respiratory devices in advanced disease
Risks
- Inhaler-related dry mouth, hoarseness and oral candidiasis
- ICS use has been associated with a slight increase in pneumonia risk
- LABA/LAMA may cause tachycardia, palpitations or urinary retention
- Risk of exacerbation and hospitalization with treatment non-adherence
- If smoking is not stopped, the disease will inevitably progress
FAQ
Can COPD be cured?
COPD is a chronic disease; treatment reduces symptoms, prevents exacerbations and improves quality of life and exercise capacity. Quitting smoking is the single most effective step in slowing disease progression.
Do I have to use inhaler medications every day?
Long-acting inhalers are used regularly in GOLD groups B and E. Regular use significantly reduces exacerbations and hospitalizations.
What is pulmonary rehabilitation, and is it necessary?
It is a multidisciplinary program that includes exercise, nutrition and education. In moderate-to-severe COPD it markedly improves shortness of breath and daily activities.
When is oxygen therapy needed?
In stable patients whose resting oxygen level is below defined thresholds, home oxygen therapy of more than 15 hours per day prolongs survival.
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