Description

COPD causes considerable morbidity and mortality, particularly in the elderly, and often remains undiagnosed. The diagnosis cannot be made without spirometry. The NICE guideline provides an evidence-based approach to COPD management. Patients with stable disease may require pharmacotherapy with short- or long-acting bronchodilators, inhaled steroids to reduce exacerbation rates, mucolytics, diuretics, oxygen, and anti-depressants as well as non-pharmacological treatments such as pulmonary rehabilitation and nutritional supplements. It is also essential that they are encouraged to stop smoking. Exacerbations of COPD occur at all stages of the disease. Mortality following exacerbations requiring hospitalization is high. Exacerbations should be managed with increased doses of bronchodilators and oral corticosteroids unless contraindicated. Antibiotics should only be prescribed if there is a history of purulent sputum. Hospital at home and assisted discharge schemes provide safe and effective alternatives to hospital therapy.