Treatment Strategies.
Non-pharmacologic treatment
Non-pharmacologic treatments such as smoking cessation, physical activity, and pulmonary rehabilitation should be provided to all COPD patients. In addition, exposure to risk factors should be promptly identified and reduced, all smokers should be encouraged to quit, and personal exposure to occupational dust, fumes, and indoor and outdoor air pollution should be reduced.
Medication
Medication is used to reduce symptoms, reduce the frequency of acute exacerbations, and improve health status and exercise tolerance.
Therapeutic drugs are gradually increased according to the severity of the disease, and regular treatment should be maintained at the same level for a long time if the patient does not experience significant drug side effects or deterioration of the disease.
Hospitals at all levels should select reasonable drug therapy based on available drugs, patient response to treatment, drug prices and other factors.
Commonly used drugs include bronchodilators, glucocorticoids, phosphodiesterase inhibitors and other drugs.
Bronchodilators include β2 agonists [short-acting drugs: salbutamol, long-acting drugs: formoterol, salmeterol, indacaterol), anticholinergic drugs (short-acting drugs: ipratropium bromide, long-acting drugs: tiotropium bromide), methylxanthines (common theophylline or slow-release theophylline) and combined preparations [combined preparations of β2 agonists and anticholinergic drugs, β2 agonists, anticholinergic drugs and/or theophylline combination].
Inhaled glucocorticoids (ICS) alone are not routinely used as treatment for COPD and are recommended for COPD patients with FEV1 < 60% of the expected value. ICS is often used clinically in combination with bronchodilators (salmeterol/fluticasone, formoterol/budesonide, or a triple combination of a long-acting β2 agonist, ICS, and tiotropium), and long-term oral hormones are not recommended.
Phosphodiesterase inhibitors (roflumilast) may be used in patients with chronic bronchitis, severe and very severe COPD, and a previous history of acute exacerbations. In COPD patients not receiving ICS, phlegmolytic agents (e.g., carboxymesterol) may be applied to reduce the frequency of acute exacerbations.
Vaccination
This includes influenza vaccination and pneumonia vaccination. For COPD patients with severe comorbidities (e.g., cardiovascular disease), annual pneumococcal polysaccharide vaccination is recommended.
Other treatments
Oxygen therapy
In patients with chronic respiratory failure with severe hypoxemia at rest, long-term oxygen therapy (more than 15 h of oxygen per day) may increase survival.
The indications for long-term oxygen therapy are: oxygen partial pressure ≤ 55 mmHg or oxygen saturation ≤ 88% with or without hypercapnia on two tests within 3 weeks; oxygen partial pressure of 55-60 mmHg or oxygen saturation of 88% with definite pulmonary hypertension, congestive heart failure or erythrocytosis (red blood cell pressure > 55%).
Ventilation support therapy
Noninvasive ventilation (NIV) has been increasingly used in stable patients with very severe COPD. In COPD patients with significant daytime hypercapnia, noninvasive ventilation combined with long-term oxygen therapy improves patient survival but not quality of life.
In patients with COPD combined with obstructive sleep apnea, continuous positive airway pressure ventilation (CPAP) has a clear benefit in terms of improving patient survival and reducing hospitalization frequency.
Surgical treatment
These include lung volume reduction surgery (LVRS), bronchoscopic lung volume reduction surgery (BLVR), lung transplantation and pulmonary alveolopexy. The surgeon may choose the procedure based on the indications.
Comorbidity treatment
Patients with COPD can have a variety of comorbidities, including cardiovascular disease, osteoporosis, depression, diabetes and lung cancer. The 2011 revision of GOLD emphasizes that COPD comorbidities should be treated according to the appropriate guidelines.