Chronic Lung Disease

Management Algorithm

Treatment of COPD

See Note (iv)

 
LABA: long-acting β2-agonist
LAMA: long-acting muscarinic antagonist
ICS: inhaled corticosteroids
 
Reassess and adjust regularly according to the response to treatment in terms of dyspnea and/or acute exacerbations

Life Saving Interventions

There are 3 life saving interventions:

  1. Smoking cessation 
  2. Chronic oxygen when stable (non-exacerbated) resting SpO2 ≤ 88% (or PaO2 ≤ 55 mmHg)
  3. Non-invasive ventilation (NIV) in individuals with persistent hypercapnic respiratory failure after an acute exacerbation

Notes:

  1. Assessment of either dyspnoea using mMRC, see https://www.verywell.com/guidelines-for-the-mmrc-dyspnea-scale-914740 or symptoms using CAT™, see http://www.catestonline.org/ and history of exacerbations (including prior hospitalisations)
  2. COPD itself has significant extra-pulmonary (systemic) effects including weight loss, nutritional abnormalities and skeletal muscle dysfunction
  3. Based on expert opinion
  4. Each pharmacological treatment should be individualised and guided by the severity of symptoms, risk of exacerbations, adverse effects, co-morbidities, drug availability and cost, and the individual’s response, preference and ability to use various drug delivery devices. Inhaler technique needs to be assessed regularly. Long-term use of oral glucocorticoids has no evidence of benefits in COPD and increase the risk of pneumonia. The addition of ICS to LAMA or LABA/LAMA is recommended in individuals with history of frequent exacerbations and/or asthma and/or eosinophilia (> 3%), or anyway in individuals not adequately controlled by LAMA/LABA combination. ICS should be avoided in subjects with eosinopenia (< 1%)
 
Do not use inhaled glucocorticoids with boosted ART regimens, see Drug-drug Interactions between Corticosteroids and ARVs.
Influenza and pneumococcal vaccination decrease rates of lower respiratory tract infections, see Vaccination