What interventions are used to treat COPD?

Management of COPD is mainly focused on preventing further deterioration and maintaining lung function and quality of life.

The only intervention that has been shown to slow the long term deteriorartion in lung function is smoking cessation (Anthonisen et al. 2005; Anthonisen et al. 1994). This page presents statistical information on three other effective interventions for COPD that can help maintain quality of life: medications, oxygen therapy and pulmonary rehabilitation.

Medications

Medications are used to prevent and control symptoms, reduce the frequency and severity of exacerbations  and improve exercise tolerance.

Most drugs used to treat COPD are also used to treat other respiratory conditions such as asthma. Tiotropium bromide is the first member of a class of drugs now available in Australia known as long-acting anti-cholinergics. Unlike most other classes of inhaled medications for airways disease, anti-cholinergic drugs are indicated for the treatment of COPD only. Tiotropium bromide was introduced into the Australian market in 2002.

Anti-cholinergics relax the muscles that surround the airways, opening the airways to relieve breathlessness.

In 2009, the proportion of people aged 55 and over who were dispensed tiotropium bromide, increased with age until 84 years and decreased after that. Men aged 60 and over had a higher rate than women in every age group.

Note: COPD occurs mostly in people aged 55 years and over. While it is occasionally reported in younger age groups, in those aged 55 years and over there is more certainty that the condition is COPD and not another respiratory condition. For this reason only people aged 55 years and over are included in this graph.

Source: Pharmaceutical Benefits Scheme.

Oxygen therapy

Long term home oxygen therapy can be prescribed for people with persistently low levels of oxygen in the blood, including from chronic lung disease, most commonly advanced COPD. In this situation, increasing oxygen in the blood for more than 15 hours per day improves survival and possibly quality of life (Medical Research Council Working Party, 1981). In Australia, long-term oxygen therapy is mostly delivered using an oxygen concentrator, a device that extracts nitrogen from room air, thereby increasing the concentration of oxygen. Sometimes oxygen cylinders are provided for short term use.

There is no national database or register of oxygen therapy in Australia, therefore no data are available on its use.

Pulmonary rehabilitation

Pulmonary rehabilitation has been shown to reduce the symptoms of COPD, increase exercise capacity, improve health related quality of life and decrease health care utilisation. It is a system of care that may include:

• Exercise training—includes aerobic training of upper and lower limbs and trunk muscles, flexibility, muscle strength and breathing control.
• Education—aims to improve the patient's knowledge about breathing, using appropriate medications and therapeutic devices and to help smokers to quit.
• Nutrition counselling—being either overweight or underweight can be a problem for people with COPD.
• Psychosocial support—assists patients if they are affected by anxiety, panic or depression.

While national guidelines for the management of COPD strongly recommend pulmonary rehabilitation for people with moderate to severe disease, many Australians do not have access to it.

Lack of data prevents further analysis of pulmonary rehabilitation.

References

Anthonisen NR, Connett JE, Kiley JP, Altose MD, Bailey WC, Buist AS et al. 1994. Effects of smoking intervention and the use of an inhaled anticholinergic bronchodilator on the rate of decline of FEV1. The Lung Health Study. JAMA 272:1497-505.

Anthonisen NR, Skeans MA, Wise RA, Manfreda J, Kanner RE & Connett JE 2005. The effects of a smoking cessation intervention on 14.5-year mortality: a randomized clinical trial. Ann Intern Med 142:233-9.

Medical Research Council Working Party, 1981. Long term domiciliary oxygen therapy in chronic hypoxic cor pulmonale complicating chronic bronchitis and emphysema. Lancet 1:681-6.

Source table

Source: Pharmaceutical Benefits Scheme.