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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 deterioration in lung function associated with COPD is assisting smokers to quit [3, 4]. Three other interventions for COPD that can help maintain quality of life and reduce symptoms are pulmonary rehabilitation, medications, and, for people with very severe disease, long-term oxygen therapy.

Some statistical information is available about supply of medications for COPD, however, there is currently a lack of nationally comparable information about access to and utilisation of pulmonary rehabilitation and oxygen therapy. Options for improving data about these interventions are discussed in a recent report Monitoring pulmonary rehabilitation and long-term oxygen therapy for people with chronic obstructive pulmonary disease (COPD) in Australia – a discussion paper [1].

Medications

Medications are used in COPD to prevent and control symptoms, reduce the frequency and severity of exacerbations and improve exercise tolerance. Some drugs used to treat COPD are also used to treat other respiratory conditions such as asthma.

For more information see Respiratory medication use in Australia 2003–2013: treatment of asthma and COPD [2].

Several new medications have recently been approved for treatment of COPD in Australia, including new long-acting bronchodilators both separately and in combination with inhaled corticosteroids or other bronchodilators. No national data are available yet about their use.

Oxygen therapy 

Long term oxygen therapy (LTOT)—the provision of supplemental oxygen therapy for 15 hours per day or more—can be prescribed for people with persistently low levels of oxygen in the blood, including from chronic lung disease, most commonly advanced COPD. Selective use of LTOT has been shown to improve quality of life and survival [6]. In Australia, LTOT is mostly delivered in the home using an oxygen concentrator, a device that removes nitrogen from room air, thereby increasing the concentration of oxygen. Sometimes oxygen cylinders are provided for short-term or portable use.

Pulmonary rehabilitation 

Pulmonary rehabilitation is one of the most effective interventions for COPD, and it is recommended for all patients with COPD who are short of breath on exertion. It is a system of care that includes education, exercise training and psychosocial support delivered by an interdisciplinary team of therapists. Pulmonary rehabilitation reduces symptoms, disability and handicap, reduces hospitalisation and improves physical and emotional function. It can help people achieve and maintain an optimal level of independence and functioning in the community. It has favourable interactions with other interventions, such as nutritional counselling and pharmacotherapy [5].

Pulmonary rehabilitation may include [5, 6]:

  • Exercise training—which aims to build patient confidence, maximise skeletal muscle, improve breathing techniques, optimise cardiovascular fitness, and encourage regular, ongoing exercise.
  • Education—explains the disease progression, how to use medicines, how treatment works, and when to ask for help. A primary component of education advice is assisting smokers to quit and sustain quitting.
  • Nutrition counselling—the provision of individually tailored dietary guidance to optimise nutritional intake and control weight loss or gain. In patients with COPD, both excess weight and low weight are associated with increased morbidity. Obesity increases the work of breathing, while poor nutritional status and insufficient energy intake may lead to impaired muscle functions causing breathing difficulties.
  • Psychosocial support—provided by support groups and other organisations. It may include emotional support, social support, and new knowledge and coping strategies to help people with COPD and their carers better manage the condition. People with COPD are vulnerable to developing symptoms of anxiety and depression, which then worsen quality of life and disability. Additional intervention by mental health specialists may be required for clinically significant symptoms of anxiety or depression.

References

  1. AIHW, Marks G, Reddel H, Guevara-Rattray E, Poulos L & Ampon R 2013. Monitoring pulmonary rehabilitation and long term oxygen therapy for people with chronic obstructive pulmonary disease (COPD) in Australia: a discussion paper. Canberra: AIHW.
  2. AIHW: Correll PK, Poulos LM, Ampon R, Reddel HK & Marks GB 2015. Respiratory medication use in Australia 2003-2013: treatment of asthma and COPD. Cat. no. ACM 31. Canberra: AIHW.
  3. 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. Journal of American Medical Association 272:1497–505.
  4. 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. Annals of Internal Medicine 142:233–9.
  5. Lung Foundation Australia 2008. A manual for pulmonary rehabilitation in Australia: Evidence base and standards (PDF). Milton: Lung Foundation Australia.
  6. Lung Foundation Australia 2015. The COPD-X Plan. Australian and New Zealand Guidelines for the management of Chronic Obstructive Pulmonary Disease 2015. Milton: Lung Foundation Australia.