Management of COPD

Once the diagnosis has been established, the aims of treatment are to alleviate symptoms, prevent progression of disease and preserve optimum lung function to improve performance of activities of daily living and enhance quality of life. The pharmacological and rehabilitation therapies that are currently being used in the management of COPD are not truly evidence based and thus a proportion of current practice is empirical.

Once the diagnosis has been established, great emphasis is placed on the cessation of smoking as one the most important aspects of management. Stopping smoking will slow the rate of lung function decline in patients with COPD as mentioned above. Unfortunately, only about one third of patients, even after extensive counseling, are able to abstain from smoking long term. Factors which encourage continuation of smoking vary from patient to patient, but include the addictive potential of nicotine, conditioned responses to certain situations (work, social or stress related), psychosocial problems, depression, poor education, peer pressure, low income, lack of other stimuli and promotional campaigns by the tobacco companies.

Nicotine replacement has been shown to be nearly twice as effective as placebo in achieving long-term cessation of smoking. Nicotine is the addictive element in cigarette smoke. When inhaled, it is rapidly absorbed into the blood stream and has half-life of about 2 hours. Withdrawal from nicotine may cause unpleasant symptoms such as anxiety, irritability, depression, anger, fatigue, sleep disruption and difficulty concentrating. These effects are most likely to occur within the first week of cessation. Nicotine replacement by chewing gum or transdermal patches may reduce withdrawal symptoms in those who are heavily addicted. These patients usually smoke more than 20 per day, require their first cigarette within 30 minutes of waking and find it difficult to refrain from smoking in non-smoking areas. These patients may require replacement therapy for 6-8 weeks following which they may be weaned off.