Chronic obstructive pulmonary disease (COPD) is characterised by persistent airway symptoms and airflow limitation due to airway inflammation and irritation (chronic bronchitis) and / or alveolar abnormalities (emphysema). COPD is caused by significant exposure to noxious particles or gases. The main risk factor for developing COPD is tobacco smoking, but other environmental exposures, such as biomass fuel exposure and air pollution, may also contribute.
The most common airway symptoms are dyspnoea, a cough, and extensive sputum production, which may significantly impact daily life. Patients with COPD may experience exacerbations, periods of acute symptom worsening that require treatment with oral corticosteroids and / or antibiotics. The diagnosis of COPD is made in patients over 40 years of age with respiratory symptoms, a relevant smoking history (more than 10 pack years), or other relevant exposure, and a persistent airflow limitation during spirometry testing after maximal bronchodilation (Z-score of the FEV1 / FVC ratio < -1.64). Usually, COPD is diagnosed by the GP.
Management of COPD involves stop-smoking counselling, dietary advice to prevent being under or overweight, exercise advice, the prescription of inhaled bronchodilators, and regular monitoring of symptoms and limitations. In case of the insufficient effect of one long-acting bronchodilator, a second bronchodilator from the other group can be added. If patients show frequent exacerbations, inhaled corticosteroids can be prescribed. A combination of two different types of bronchodilators plus corticosteroid inhalators is called ‘triple therapy’.