What is COPD MANAGEMENT?

COPD including “pink puffer” and “blue bloater” is both a treatable as well as a preventable disease but currently there is no cure for this disease. Assessing and monitoring the disease are the currently available major directions of COPD. The other directions include managing stable COPD, reducing the risk factors, treat and prevent acute exacerbations as well as manage comorbidity. Also available are clinical practice guidelines for managing COPD. To reduce the mortality of this disease the only measures that have been shown is supplemental oxygen and smoking cessation.

Reduction in risk factors:

One of the most important factors for slowing down the progression of COPD is smoking cessation. After diagnosis the patient is recommended to slow down or stop smoking to slow down the rate of the progression of the disease. Rate of deterioration in the lung function can be significantly reduced and the onset of death and disability can be delayed. The rate of progression of COPD can be improved only by standard intervention. The individual himself has to decide to stop smoking which finally leads to quitting smoking altogether. Before long term smoking cessation is achieved several attempts are required.

Some people have a strong will power to achieve long term cessation of smoking. Many smokers need further support to quite as smoking is a highly addictive habit. Trying to engage in a smoking cessation program, social support, and using drugs such as nicotine replacement therapy, varenicline and bupropion help in increasing the chances of successfully stopping smoking. Smoking rates can be reduced by the polices of anti smoking organizations, public health agencies and governments by discouraging people from starting to smoke as well as encouraging smoking cessation. If COPD has to be prevented then these policies make important strategies.

Improve air quality and take appropriate measures:

Air pollution needs to be reduced to improve the health of people suffering with COPD. Pollution reduction efforts help in improving air quality. It is better if a person suffering from COPD stays indoors when the quality of air is poor and by doing this he is sure to face fewer symptoms of the disease.  As far as occupational health is concerned workers in coal mining companies etc. should not be exposed to great extents to chemicals causing COPD.

Workers are always at risk at such companies, so appropriate measures need to be taken by educating workers, making them aware, managing risk areas, promoting smoking cessation, use of personal dust monitors, surveillance of workers for checking early signs of COPD, use of dust control, use of respirators etc. To minimize dust generation, mining techniques and water sprays can be used. Improved ventilation also helps to achieve dust control. Ongoing dust exposure can be reduced by disallowing the worker to be more exposed to dust. Work role of the affected worker can be changed.

Stable COPD – Its management:

Bronchodilators

Smooth muscles around the airways in the lungs need be relaxed so that they can improve airflow and increase the caliber of the airways, for which bronchodilators are used. These medicines help to wheeze and exercise limitation, reduce the symptoms of shortness of breath which then improves the quality of life of people suffering from COPD. Rate of progression of the underlying disease is not slowed down by bronchodilators and are usually administered via a nebulizer or with an inhaler. Anticholinergics and ß2 are the two major types of bronchodilators.

Anticholinergic medicines help in relaxing airway smooth muscles by blocking stimulation for the cholinergic nerves. Rapid relief is provided of the COPD symptoms  with short acting anticholinergics and ipratropium is a short-acting anticholinergic which is prescribed widely. Long-acting anticholinergic drug called tiotropium is also commonly used and its regular use shows better exercise capacity, improvement in airflow, longer and better quality of life.

The other bronchodilator is ß2 agonists which cause airway smooth muscles to relax by stimulating ß2 receptors. Albuterol (common brand name: Ventolin) and terbutaline are widely used short acting ß2 agonists available. They provide rapid relief of COPD symptoms. salmeterol and formoterol are long acting ß2 agonists (LABAs) lead to improved quality of life, better exercise capacity and better airfllow and used as maintenance therapy. While ß2 agonists have no effect on respiratory deaths, Anticholinergeics reduces respiratory deaths and hence   Anticholinergics appear to be superior to ß2 agonists in COPD.

Corticosteroids

Unlike bronchodilators, corticosteroid does not take action directly on the airway smooth muscle and do not provide immediate relief of symptoms. They help in reducing the swelling in the airways, in theory reducing airway narrowing and lung damage caused by inflammation. Mometasone, budesonide, flucticasone, and beclomethasone are some of the common corticosteroids used in inhaled form or tablet form to treat. There are also other medications like theophylline and phosphodiesterase inhibitor used in the reducing the symptoms of COPD.

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