COPD Management

Written by  – Dr Andrew Lam

Chronic Obstructive Pulmonary Disease (COPD)

Chest X-Ray Findings of COPD

• Flattening of the hemidiaphragms
• Narrowing of the mediastinum
• Hyperlucency of the lung fields
• Decreased peripheral broncho-vascular markings
• Hyperinflation (More more than 6 anterior ribs or 10 posterior ribs visible above the diaphragm in the mid-clavicular line

Gold Classification for Severity of Airflow Limitation

FEV1 – Forced expiratory volume in 1 second

Escalation of Long-Term COPD Therapy

Step 1: Long Acting Bronchodilator Monotherapy (i.e. LAMA or LABA)
Long-Acting Muscarinic Antagonists (LAMA’s) – tiotropium, glycopyrronium, aclidinium
Long-Acting Beta2 Agonists (LABA’s) – formoterol, salmeterol, indacaterol

Step 2: LAMA + LABA
e.g. Spiolto (olodaterol + tiotropium), Anoro (vilanterol + umeclidinium)

Step 3 :Inhaled corticosteroid (ICS) + LAMA + LABA
e.g. Trelegy (fluticasone + umeclidinium + vilanterol), Spiriva (tiotropium) + Seretide (Fluticasone + salmeterol)

References: 

Weerakkody, Y., Ho, M.L. et al. (2020) Chronic obstructive pulmonary disease. Retrieved January 30, 2021 from https://radiopaedia.org/articles/chronic-obstructive-pulmonary-disease-1?lang=gb

Han, M.K., Dransfield., M.T., Martinez., F.J. (2020). Chronic obstructive pulmonary disease: Definition, clinical manifestations, diagnosis and staging. UpToDate. Retrieved January 30, 2021, from https://www.uptodate.com.acs.hcn.com.au/contents/chronic-obstructive-pulmonary-disease-definition-clinical-manifestations-diagnosis-and-staging

Electronic Therapeutic Guidelines. (2020) Stable chronic obstructive pulmonary disease (COPD). eTG Complete. Retrieved January 30, 2021, from https://tgldcdp.tg.org.au.acs.hcn.com.au/viewTopic?topicfile=chronic-obstructive-pulmonary-disease&sectionId=rsg6-c13-s10#toc_d1e1247