Contents
OVERVIEW
Definition of COPD
- A preventable & treatable disease w/ overall severity contributed by exacerbations & comorbidities
- The persistent airflow limitation is usually progressive & associated w/ an enhanced chronic inflammatory response in the airways & the lung to noxious particles or gases
- The chronic airflow limitation is caused by a mixture of small airways disease & parenchymal destruction
Risk Factors for COPD
Host Factors
- Hereditary deficiency of alpha-1 antitrypsin
- Airway hyper-responsiveness
- Includes asthma
- May also develop after exposure to tobacco smoke or other environmental insults
- Lung growth & development
- Individuals may have reduced maximal attained lung function due to processes during gestation & childhood
- Infections
- Reduced lung function can be associated w/ a history of severe childhood resp infections
- Previous tuberculosis
Exposures
- Tobacco smoke
- Most commonly encountered risk factor
- Includes history of tobacco use or prolonged exposure to second-hand smoke
- Smoking during pregnancy can put the fetus at risk
- Occupational dusts & chemicals
- Air pollution
- Smoke from home cooking & heating fuels
- Socioeconomic status
Definition of COPD Exacerbation
- An acute event wherein the patient’s symptoms worsen beyond normal daily variations that leads to change in medication
- Viral & bacterial respiratory tract infections are the common causes
- Exacerbations caused by bacterial etiology in 50% of patients
- Other causes: air pollution, interruption of maintenance medications, other comorbidities (GERD)
Signs & Symptoms of COPD Exacerbation
- Increased breathlessness, wheezing, chest tightness
- Increased cough & sputum, change in color &/or tenacity of sputum
- Fever, malaise, fatigue, depression, confusion, sleep disturbances, decreased exercise tolerance
- Resp rate >25 breaths/min, heart rate >110/min, use of accessory muscles for breathing &/or dyspnea at rest may indicate severe acute exacerbation
Below is the overview of the disease management of Chronic Obstructive Pulmonary Disease:

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Arrange For Follow-Up Assessments
- A follow-up assessment must be carried out w/in 4-6 wk following discharge from hospital for exacerbations
- Check patient’s ability to cope in his environment
- Measure FEV1
- Check inhaler technique
- Check understanding & ability to follow of treatment regimen
- Assess need for long-term O2 therapy &/or home nebulizer for patients w/ very severe COPD
- Check status of comorbidities
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Version: 31 July 2015
Guideline References:
- Alberta Medical Association. Guideline for the management of acute exacerbations of chronic bronchitis (AECB)/acute or chronic COPD. http://www.albertadoctors.org/resources/cpg/aecb-guideline.pdf. May 2000. Accessed 05 Aug 2002
- Ambrosino N, Vagheggini G. Non-invasive ventilation in exacerbations of COPD. Int J Chron Obstruct Pulmon Dis. 2007 Dec;2(4):471-476. PMID: 18268921
- American Thoracic Society. COPD assessment test (CAT). American Thoracic Society website. http://www.thoracic.org/assemblies/srn/questionaires/copd.php. 2014.
- American Thoracic Society. Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1995 Nov;152(5)(Pt 2):S77-S121. PMID: 7582322
- Blanchard AR. Treatment of COPD exacerbations: pharmacologic options and modification of risk factors. Postgrad Med. 2002 Jun;111(6):65-75. PMID: 12082921
- Decramer M, Celli B, Kesten S, et al; UPLIFT investigators. Effect of tiotropium on outcomes in patients with moderate chronic obstructive pulmonary disease (UPLIFT): a prespecified subgroup analysis of a randomised controlled trial. Lancet. 2009 Oct;374(9696):1171-1178. PMID: 19716598
- Doherty DE. Early detection and management of COPD: what you can do to reduce the impact of this disabling disease. Postgrad Med. 2002 Jun;111(6):41-4, 49-50, 53 passim. PMID: 12082920
- Ferguson GT, Calverley PM, Anderson JA, et al. Prevalence and progression of osteoporosis in patients with COPD: results from the Towards a Revolution in COPD Health study. Chest. 2009 Dec;136(6):1456-1465. PMID: 19581353
- Global Initiative for Chronic Obstructive Lung Disease. At-A-Glance outpatient management reference for chronic obstructive disease (COPD). Based on the global strategy for diagnosis, management and prevention of COPD Global Initiative for Chronic Obstructive Lung Disease (GOLD) revised 2011. http://www.goldcopd.org/uploads/users/files/GOLD_AtAGlance_2011_Jan18.pdf. Jan 2012
- Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. http://www.goldcopd.org/uploads/users/files/GOLD_Report_2011_Feb21.pdf. 2011
- Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Updated 2014. Global Initiative for Chronic Obstructive Lung Disease website. http://www.goldcopd.org/uploads/users/files/GOLD_Report2014_Feb07.pdf. 2014. Accessed 15 Apr 2015.
- Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Updated 2015. GOLD website. http://www.goldcopd.org/uploads/users/files/GOLD_Report_2015_Apr2.pdf. 2015. Accessed 30 Apr 2015.
- Global Initiative for Chronic Obstructive Lung Disease. Pocket guide to COPD diagnosis, management, and prevention. A guide for health care professionals. Updated 2014. http://www.goldcopd.org/uploads/users/files/GOLD_Pocket2014_Jan30.pdf. 2014.
- Gross N, Levin D. Primary care of the patient with chronic obstructive pulmonary disease-part 2: pharmacologic treatment across all stages of disease. Am J Med. 2008 Jul;121(7)(Suppl):S13-S24. PMID: 18558103
- Institute for Clinical Systems Improvement (ICSI). Health care guideline: chronic obstructive pulmonary disease. http://www.icsi.org. 2004
- Ministry of Health Singapore. Clinical practice guidelines: chronic obstructive pulmonary disease. MOH (Singapore). http://www.moh.gov.sg. 2006
- National Clinical Guideline Centre. Chronic obstructive pulmonary disease: management of chronic obstructive pulmonary disease in adults in primary and secondary care. http://guidance.nice.org.uk/CG101/Guidance/pdf/English. 2010
- National Collaborating Centre for Chronic Conditions. Chronic obstructive pulmonary disease. National clinical guideline on management of chronic obstructive pulmonary disease in adults in primary and secondary care [full version of NICE guideline No.12]. Thorax. 2004 Feb;59(Suppl 1):001-232. PMID: 15041752
- National Heart, Lung and Blood institute. Global Initiative for Asthma. Global strategy for asthma management and prevention. http://www.ginasthma.org/local/uploads/files/GINA_Report_072007_1.pdf. 2006.
- National Heart, Lung, and Blood Institute. Global Initiative for Asthma. Global strategy for asthma management and prevention Updated 2009. 2009
- National Institute for Health and Care Excellence. Chronic obstructive pulmonary disease: management of chronic obstructive pulmonary disease in adults in primary and secondary care. NICE. http://www.nice.org.uk/nicemedia/pdf/cg012_niceguideline.pdf. 2004
- O'Donnell DE, Aaron S, Bourbeau J, et al. Canadian Thoracic Society recommendations for management of chronic obstructive pulmonary disease - 2007 update. Can Respir J. 2007 Sep;14(Suppl B):5B-32B. PMID: 17885691
- O'Donnell DE, Hernandez P, Kaplan A, et al. Canadian Thoracic Society recommendations for management of chronic obstructive pulmonary disease - 2008 update - highlights for primary care. Can Respir J. 2008 Jan;15(Suppl A):1A-8A. PMID: 18292855
- Qaseem A, Snow V, Shekelle P, et al; Clinical Efficacy Assessment Subcommittee of the American College of Physicians. Diagnosis and management of stable chronic obstructive pulmonary disease: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2007 Nov;147(9):633-638. PMID: 17975186
- Qaseem A, Wilt TJ, Weinberger SE et al. Diagnosis and management of stable chronic obstructive pulmonary disease: a clinical practice guideline update from the American College of Physicians, American College of Chest Physicians, American Thoracic Society, and European Respiratory Society. Ann Intern Med. 2011 Aug;155(3):179-191. http://annals.org/data/Journals/AIM/11730/0000605-201108020-00008.pdf. PMID: 21810710
- Rennard SI. Overview of causes of COPD. New understanding of pathogenesis and mechanisms can guide future therapy. Postgrad Med. 2002 Jun;111(6):28-38. PMID: 12082919
- Snow V, Lascher S, Mottur-Pilson C; Joint Expert Panel on Chronic Obstructive Pulmonary Disease of the American College of Chest Physicians and the American College of Physicians-American Society of Internal Medicine. Evidence base for management of acute exacerbations of chronic obstructive pulmonary disease. Ann Intern Med. 2001 Apr;134(7):595-599. PMID: 11281744
- Tashkin DP, Celli B, Senn S, et al for the UPLIFT Study Investigators. A 4-year trial of tiotropium in chronic obstructive pulmonary disease. N Engl J Med. 2008 Oct;359(15):1543-1554. PMID: 18836213
- The Asia Pacific COPD Roundtable Group. Global Initiative for Chronic Obstructive Lung Disease strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease: an Asia-Pacific perspective. Respirology. 2005 Jan;10(1):009-17. PMID: 15691232
- Yassin HM, Dever LL. Telithromycin: a new ketolide antimicrobial for treatment of respiratory tract infections. Expert Opin Investig Drugs. 2001 Feb;10(2):353-367. PMID: 11178347