Chronic Obstructive Pulmonary Disease (COPD)

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This term has replaced "chronic bronchitis and emphysema".

There are many aspects of management:

  • All patients with a clinical diagnosis of COPD should have a spirometry lung function testing. This is done to assess for obstruction, assess the severity of the disease and to exclude asthma by demonstrating reversibility or non-reversibility of the obstruction.
  • Stop smoking and/or remove from hazardous (dusty) environment.
  • Prompt treatment of infective exacerbations (or as for pneumonia):

Treatment of COPD exacerbation

Give antibiotics if sputum colour has changed to purulent, fever or new chest Xray infiltrates.

Medicine Adult Dose Frequency Duration
amoxicillin po 500mg 3 times a day 7 days
or 

doxycycline po

 100mg once a day 7 days

For airway obstruction and dyspnoea add:

Mild /Moderate Disease and patient able to use inhaler (check technique):

Medicine   Adult dose Frequency   Duration
salbutamol inhaler  100-200mcg 6 hourly      review
plus ipratropium inhaler 40mcg 6 hourly      review

If dyspnoea is severe:

Medicine Adult Dose Frequency       Duration
salbutamol nebulised 5mg 6 hourly    review

plus   

ipratropium nebulised

 500mcg 6 hourly    review

and

prednisolone po

 30mg once a day  7-14 days
  • Preferably drive the nebuliser with air rather than oxygen.
  • Controlled oxygen therapy - 2 litres/minute by nasal prongs or 28% ventimask (Avoid higher concentrations of oxygen unless there is access to blood gas analyser). If it is possible to monitor oxygen saturation aim for SPO2 88-92%
  • Provide pulmonary rehabilitation to prevent respiratory muscle wasting and deconditioning.
  • Provide nutritional support.

Management of stable COPD

  • Overall management of patients with stable COPD is individualised.
  • Use of bronchodilators
  • If the patient has mild symptoms and infrequent exacerbations (1 or nil per year) use:
Medicine Adult Dose Frequency Duration
salbutamol Inhaler  200mcg Twice a day PRN
If no improvement add:
ipratropium inhaler 40mcg   PRN  

If the patient has frequent to persistent symptoms of breathlessness and frequent exacerbations (more than 1 per year) refer to a specialist whilst trying the following:
beclomethasone inhaler 200mcg Twice a day PRN
plus salbutamol Inhaler 200mcg  PRN  
  • Alternatively adding Theophylline SR 250-500mg PO once daily may be helpful if patients remain symptomatic.
  • Provide pulmonary rehabilitation
  • Provide nutritional support
  • Vaccinations: Influenza and pneumococcal vaccines
  • Enquire about symptoms of gastro-eosophageal reflux disease (GERD) and treat.