COPD & Smoking Cessation
Chronic obstructive pulmonary disease, or COPD, is the third-leading cause of death in the U.S. following cancer and heart disease, and it is a significant global public health issue.1 Smoking is by far the most common contributing cause of COPD in industrialized countries, although exposure to biomass smoke may be the biggest risk factor globally. There is a close relationship between the amount of tobacco smoked and the rate of decline in FEV1, although people vary greatly in their susceptibility to tobacco smoke damage.
COPD is substantially under-diagnosed and can occur at an earlier age than is generally believed.2 A diagnosis of COPD should be considered in any patient with dyspnea, chronic cough, or chronic sputum production, and/or history of exposure to risk factors for the disease (especially tobacco smoke). Spirometry is the gold standard diagnostic tool and is required for the optimal diagnosis and staging of COPD.
This module summarizes the current understanding of COPD and presents evidence-based clinical guidelines for its diagnosis and treatment in the primary care setting.
Using the current GOLD COPD Classification to characterize disease severity3
The current Global initiative for Chronic Obstructive Lung Disease (GOLD) classification of COPD severity includes factors beyond airflow obstruction, such as symptoms (dyspnea and cough) and the frequency of acute exacerbations, in order to better characterize disease severity. The criteria are formulated in terms of groups determined by both risk and symptom severity.3
GOLD COPD Classification Guide
Management of COPD
Aggressive management of COPD can alter the natural history of the disease, and non-pharmacologic approaches can be really beneficial. The goals of COPD management include:
- relieving symptoms
- reducing mortality
- improving exercise capacity
- improving health status and quality of life
- reducing the number and severity of exacerbations
- preventing disease progression
- identifying and treating exacerbations if they do occur
- preventing and treating complications
- ensuring appropriate end-of-life planning and palliation
Pharmacological therapy of COPD should be matched to severity of the disease.3 The table below provides recommendations for first-line therapy as well alternative therapies for each patient group.
Bronchodilators remain the cornerstone of therapy across all groups. It is preferable to initiate therapy with a short-acting bronchodilator (a ß-agonist or an anticholinergic) rather than a combination. For increasing symptoms, long-acting bronchodilators reduce exacerbations and provide more relief than short-acting agents. However, all patients should have short-acting bronchodilators as rescue medication.
Pharmacological Management of COPD3
Prescribing a regimen of exercise, good nutrition, and immunization at all stages of COPD is essential.
Non-pharmacological Management of COPD3
Exacerbations reduce long-term lung function and increase mortality
Promoting smoking cessation, ensuring adherence to prescribed regimens, monitoring proper inhaler use and providing influenza immunizations, can reduce the risk of exacerbations in patients with COPD. Most exacerbations can be managed in the outpatient setting.3,4
Management of COPD Exacerbations
- American Association of Cardiovascular and Pulmonary Rehab
- ATS/European Respiratory Society (ERS) - Pulmonary Rehabilitation statement
Information current at time of publication, November 2016.
The content of this website is educational in nature and includes general recommendations only; specific clinical decisions should only be made by a treating physician based on the individual patient’s clinical condition.
- American Lung Association. Trends in COPD (Chronic Bronchitis and Emphysema): Morbidity and Mortality. 2013.
- Pauwels RA, Rabe, K. F. Burden and clinical features of chronic obstructive pulmonary disease (COPD). Lancet. Aug 14-20 2004;364(9434):613-620.
- GOLD. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. 2016.
- Leuppi JD, Schuetz P, Bingisser R, et al. Short-term vs conventional glucocorticoid therapy in acute exacerbations of chronic obstructive pulmonary disease: the REDUCE randomized clinical trial. JAMA. 2013;309(21):2223-2231.