Management

A COPD management programme includes the following four components: assessment and monitoring of disease; reduction of risk factors; management of stable COPD; and management of exacerbations. The goals of COPD management are to relieve symptoms, prevent disease progression, improve exercise tolerance, improve health status, prevent and treat complications and exacerbations, reduce mortality and prevent or minimise side-effects from treatment.

Important components of management are smoking cessation, medical treatment with bronchodilators as well as inhibitors of inflammation, physical exercise and, in advanced disease, oxygen therapy (see chapter 28).

Early rehabilitation after exacerbations is important (see chapter 29). The most effective component of pulmonary rehabilitation is physical exercise.

In the future, better classification of the different phenotypes of COPD is likely to enable implementation of personalised treatment, in which the characteristics of the patient together with the severity of the disease are the keys to choosing the best treatment option.

Comorbidities should be assessed at all stages of COPD. Differential diagnosis can often be difficult, as comorbidities with symptoms commonly seen in COPD may be overlooked, for instance heart failure or lung cancer causing breathlessness or depression presenting with fatigue. In general, any comorbiditity should be treated as in patients who do not have COPD.

See the entire Obstructive pulmonary disease Chapter