Managing COPD correctly leads to less exacerbations and better quality of life

COPD is an underdiagnosed and poorly understood complex syndrome. Comprehensive management, including personalised action plan, is essential for effective treatment of the disease.

COPD (Chronic obstructive pulmonary disease) is a chronic disease that affects around 36 580 000 people in Europe alone. The number could be higher as COPD is often left undiagnosed, which is a problem in many countries, says pulmonologist Witold Mazur, Specialist in Respiratory Medicine and Allergology at Helsinki University Hospital.

COPD has overlap with asthma and other diseases that leads to some misdiagnoses and ineffective use of medical resources. Sometimes people with acute presentation of prolonged symptoms, such as breathlessness and cough, are treated at emergency departments, which is problematic.

"While the acute symptoms are treated, the problem remains. After the emergency examination a doctor should refer the patients for further medical assessments, but they are often left without proper diagnostics or a plan for management of a possible lung disease. We need to solve this issue,” Mazur says.

No two patients are the same

The main symptom of COPD is breathlessness, and the diagnosis is based on an indication of a permanent obstruction of the lungs confirmed by spirometry. Based on his clinical experience Mazur has noticed that no two patients are the same.

“As far as I understand, COPD is recognised as a syndrome that includes a group of phenotypes of the same, very complex disease. Each patient has its own clinical presentation, which is a very good reason to individualise the diagnostic approach and the management of the disease,” he says.

COPD is often considered as self-inflicted or a smokers' disease, which is why there is stigma attached to it. But no matter the cause of the disease, it is important that every patient will be taken care of – even if they continue to smoke.

It is true that COPD patients often have a history of smoking but not always, Mazur says. He has seen patients who have never smoked but might have been exposed to passive smoking or toxins in their past, and may not even be aware of this.

“Even physicians and medical practitioners often assume that COPD is self-inflicted and because of this there could be a percentage of ex-smokers suffering from prolonged symptoms who do not even attempt to seek medical help. We should not generalise and think that COPD only affects smokers," Mazur says. 

All patients should have action plan

Management of COPD is based on medical and non-medical procedures. According to Mazur the most important thing is to stop smoking and remain non-smoking. Pharmaceutical treatment for COPD includes the usage of inhaled bronchodilators alone, or combined with inhaled corticosteroids when indicated. It is crucial that the correct inhalation technique of an inhaler device is always instructed by a medical practitioner.

The initial diagnostics and management plan should always be done on site by a care team including a doctor, a nurse, a physiotherapist, and, if necessary, a nutritionist. When the patient is known and their disease is under control, follow-up visits could be performed remotely if this is what best suits the patient.

Regular exercise, balanced diet and healthy living habits are also crucial when treating COPD. Preventing infections by avoiding people who are ill and by taking the recommended vaccinations including influenza, COVID-19, and pneumococcal, is important because infections can trigger exacerbations.

Mazur emphasises that COPD patients should always have a written action plan counselling how to manage worsening symptoms in case of exacerbations. The plan should include a prescription for oral corticosteroids and an antibiotic, which are taken on top of the inhaled medication if exacerbations occur.

Based on Mazur’s clinical experience less than half of the patients experience at least one exacerbation that requires hospitalisation per year and around 10 % have more frequent episodes that might in some cases require hospitalisation.

"Most exacerbations are quite mild, and the patient can manage these at home. Besides the prescriptions, the action plan should also include a written instruction on when and how to take these, as well as a contact number for a health care provider to give the patient a sense of security with the disease,” Mazur says.

Most COPD patients manage symptoms well

COPD cannot be cured because the lung tissue has been permanently damaged. The goal of the treatment is to improve the patient’s quality of life and to aim to lessen the symptoms.

"The presentation of the disease in majority of the patients is quite moderate and definitely more than half of the patients manage to keep the symptoms under control using the inhaled medication and by following healthy living habits. Even if we cannot cure the disease, there are many things we can do together to help the patient," Mazur concludes.

By Laura Iisalo

Photo by Adobe Stock

Reference:

1. An estimate of the European prevalence of COPD in 2050. Adam Benjafield, Daniela Tellez, Meredith Barrett, Rahul Gondalia, Carlos Nunez, Jadwiga Wedzicha, Atul Malhotra, European Respiratory Journal Sep 2021, 58 (suppl 65) OA2866; DOI: 10.1183/13993003.congress-2021.OA2866 https://erj.ersjournals.com/content/58/suppl_65/OA2866

Date of preparation: January 2023 / EASYH-2857

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