Treatment Plan

Treatment Plan

Conservative:

Smoking cessation

Self-management plan

Medical:

1st line: SABA or SAMA 2nd line:

With asthmatic features: ICS + LABA (increased pneumonia risk when using ICS in COPD patients)
Without asthmatic features: LABA + LAMA
3rd line (for those w/ or without asthma features): Triple therapy (LABA + LAMA + ICS)

[Do a 3-month trial for those with no asthmatic features & if not better to go back to LAMA + LABA]

Additional:

Long-term oxygen therapy (if O2 sats <90%, severe/very severe FEV1) – Oral mucolytics: Carbocysteine, acetylcysteine (CI: Pregnancy/BF, Active peptic ulceration|AE’s: Skin rash/GI symptoms)
Corticosteroids: Acute exacerbations or long-term use (LT use needs referral)
Theophylline: Before starting, check U&E + LFTs. Plasma levels are checked 5 days post start, 3 days after dose adjustment & 6-12 monthly as routine monitoring (CI: recent MI | AE:

Hypokalaemia)

Prophylactic antibiotics (Indication – >3 exacerbations with one hospital): Azithromycin 500mg 3x/week for 12 months. ECG monitoring for QT prolongation, baseline LFT’s & sputum samples before initiating azithromycin
Phosphodiesterase inhibitors: Specialist initiation only

Acute exacerbation:

Salbutamol (inhaler, possible nebulisers if inhaler not sufficient)

Prednisolone (30mg for 5 days)

Antibiotics (Amoxicillin, doxycycline, clarithromycin)

If there is a risk of treatment failure, consider Co-amoxiclav (500/125mg TDS for 5/7)

When to refer:

Diagnostic uncertainty
Family history of alpha-1 antitrypsin deficiency
Age <40, Severe/worsening COPD, Suspected lung cancer, Cor pulmonale, Bronchiectasis,

Considering long-term corticosteroids/lung surgery

Prognosis

Based on FEV1:

MRC Dyspnoea scale (1-5) used to assess symptom severity

RESPIRATORY