What is the patient's history of Chronic Obstructive Pulmonary Disease (COPD)?

From the Guidelines

A comprehensive medical history is crucial for patients with COPD, including exposure to risk factors, past medical history, family history, pattern of symptom development, history of exacerbations, presence of comorbidities, and impact of disease on patient's life. When taking a medical history of a patient with COPD, it is essential to consider the following key elements:

• Exposure to risk factors, such as smoking and occupational or environmental exposures 1
• Past medical history, including asthma, allergy, sinusitis, or nasal polyps; respiratory infections in childhood; other chronic respiratory and nonrespiratory diseases 1
• Family history of COPD or other chronic respiratory diseases 1
• Pattern of symptom development: age of onset, type of symptom, more frequent or prolonged “winter colds,” and social restriction 1
• History of exacerbations or previous hospitalizations for a respiratory disorder 1
• Presence of comorbidities, such as heart disease, osteoporosis, musculoskeletal disorders, and malignancies 1
• Impact of disease on patient’s life, including limitation of activity, missed work and economic impact, and feelings of depression or anxiety 1
• Social and family support available to the patient 1
• Possibilities for reducing risk factors, especially smoking cessation 1

According to the 2023 Canadian Thoracic Society guideline on pharmacotherapy in patients with stable COPD, a comprehensive approach to COPD management is both effective and recommended, including confirming a diagnosis of COPD with spirometry, evaluating symptom burden, health status, and risk of exacerbations over time, and implementing pharmacological and nonpharmacological treatments 1. The goal of COPD management is to improve symptoms, prevent acute exacerbations, and reduce mortality, and a comprehensive medical history is essential to achieve these goals.

From the FDA Drug Label

The subjects had an established history of COPD and exacerbations, a pre-bronchodilator FEV1 <70% of predicted at trial entry, and 8. 3% reversibility. A total of 1,579 subjects had an established history of COPD (but no other significant respiratory disorders). Subjects had a pre-bronchodilator FEV1 of 33% of predicted, a mean reversibility of 23% at baseline, and a history of ≥ 1 COPD exacerbation in the previous year that was moderate or severe

The drug label indicates that the subjects in the trials had an established history of COPD. Key points about the subjects' COPD history include:

• Established history of COPD and exacerbations
• Pre-bronchodilator FEV1 <70% of predicted at trial entry
• History of ≥ 1 COPD exacerbation in the previous year that was moderate or severe 2

From the Research

COPD History

• COPD is a common respiratory disease characterized by persistent respiratory problems, and it has become a major public health concern worldwide as the population ages 3.
• The disease contributes significantly to the morbidity of patients, leading to an accelerated decline in lung function, reduced functional status, reduced health status and quality of life, poorer prognosis, and increased mortality 4.
• Exacerbations of COPD are a major concern, and prevention of these exacerbations is an important goal of COPD management 4, 5.

Treatment and Management

• Treatment with a combination of the inhaled corticosteroid fluticasone propionate and the long-acting beta(2)-agonist salmeterol has been shown to reduce the frequency of exacerbations, improve lung function, dyspnea, and health status, and be relatively cost-effective as a COPD maintenance therapy 4, 5.
• Fluticasone propionate and salmeterol have synergistic effects when administered together, improving their efficacy in controlling symptoms and reducing exacerbations 4, 5.
• Pulmonary rehabilitation combined with fluticasone propionate and salmeterol inhalation can reduce recurrence rates, improve pulmonary function, inflammatory status, and exercise tolerance, and enhance the quality of life for elderly patients with stable COPD 6.

Diagnosis and Examination

• Diagnosis of COPD requires pulmonary function tests, but medical interviews and physical examinations are also crucial in acquiring important information about the disease 3.
• History taking, physical examination, and blood examination can provide important information about the severity of the disease, risk of future events, and prognosis 3.
• Maintenance and reliever therapy with inhaled corticosteroid/formoterol may be similarly effective to fixed-dose fluticasone/salmeterol therapy in moderate to severe patients with COPD, at a lower daily ICS dosage 7.