COPD is diagnosed in patient having above risk factors like Cigarette smoking, biomass fuel usage etc who had gradually progressive difficulty in breathing, cough in whom Pulmonary Function Test called Spirometry shows Obstruction i.e. Post bronchodilator FEV1/FVC Ratio <0.70. Ironically, most of the center does not have Spirometry despite its being economical and simplicity. Thence, making only clinical diagnosis which at significant number of times either underdiagnose or overdiagnose COPD.
- Smoking Cessation/ Avoidance or Minimization of Biomass fuel utilization
- Vaccination: Influenza (Annual) & Pneumococcal vaccination
- Pulmonary Rehabilitation /Exercise
- Adherence to treatment
COPD is usually treated with bronchodilator medications like Tiotropium, Glycopyrenium, Formoterol, Salmeterol and corticosteroids like budesonide, fluticasone etc in various combinations based on severity of disease. These medications are usually given in inhaler form which is directly delivered to the lungs leading to maximum effect and minimal systemic side effects. Most common ways of delivering these drugs are via Metered dose inhaler with spacer, Dry Powder Inhaler, Breath actuated devices and Nebulization. All these delivery devices are equally good with No superiority of one device over other.
However, selection of device should be individualized and discussed with patient. Various factors like Old age, arthritis, poor inspiratory effort, cognitive level will help guide best device for an individual.
In addition to above medical therapy, many patients may require long term oxygen therapy and Non invasive ventilator (BiPAP) support in home based on disease severity. Various surgical options are available outside our nation for advance stage diseases.
Moreover, proper adherence and ineffective use of these devices leads to worsening of conditions. Hence proper technique should be taught and checked on follow-up visit.
Importantly, Patient should be given advice regarding nutrition intake. They should be encouraged to eat calorie/energy dense food in small amount and multiple times a day.
Patients with COPD comes with various common co morbidities which should be addressed and treated accordingly.
- Depression/Anxiety/Cognitive impairment
- Cardiovascular diseases like Heart failure, Ischemic Heart Disease and Arrhythmia Hypertension etc
- Lung Cancer
- Metabolic Syndrome and Diabetes
- Gastro Esophageal Reflux Diseases
- Obstructive Sleep Apnea