From the Guidelines
Chronic Obstructive Pulmonary Disease (COPD) is characterized by persistent respiratory symptoms, including dyspnea, cough, and/or sputum production, which are the most frequent symptoms, as stated in the 2017 report by the Global Initiative for Chronic Obstructive Lung Disease 1.
Key Symptoms of COPD
The symptoms of COPD can vary, but the most common ones include:
- Persistent cough with mucus production
- Shortness of breath, especially during physical activity
- Wheezing
- Chest tightness
- Frequent respiratory infections Many patients also experience fatigue, unintended weight loss, and swelling in the ankles, feet, or legs in advanced stages.
Importance of Early Diagnosis
Early symptoms are often mild and may be mistaken for a cold, but they progressively worsen, particularly if the person continues smoking, as noted in the BTS guidelines for the management of COPD 1.
Underdiagnosis of COPD
The underdiagnosis of COPD in primary care is widespread, with 20% of patients with risk factors for COPD meeting spirometry criteria for moderate, severe, or very severe COPD, as reported in a study published in Chest in 2011 1.
Clinical Diagnosis of COPD
The clinical diagnosis of COPD is suggested by symptoms, but can only be established firmly by an objective measurement indicating airflow obstruction, as stated in the BTS guidelines for the management of COPD 1.
Management of COPD
The goals of COPD management aim to improve symptoms, lung function, and health status and to reduce exacerbations, disease progression, and mortality, as noted in the unified front against COPD: clinical practice guidelines from the American College of Physicians, the American College of Chest Physicians, the American Thoracic Society, and the European Respiratory Society 1. Therefore, it is essential to seek medical evaluation promptly if experiencing symptoms of COPD, particularly smokers or those with occupational exposure to lung irritants, to improve morbidity, mortality, and quality of life outcomes 1.
From the Research
Symptoms of COPD
- COPD is a respiratory disorder characterized by largely irreversible changes in air flow due to irritants such as tobacco smoke 2
- Patients with COPD experience acute exacerbations, and severe disease may progress to chronic respiratory failure 2
- Symptoms of COPD include dyspnea, breathlessness, and acute exacerbations 2, 3, 4
Treatment of COPD
- Eliminating exposure to cigarette smoke and other irritants is the only measure known to improve the outcome of COPD 2
- Inhaled short-acting beta-2 agonists, such as salmeterol and formoterol, have been shown to improve dyspnea and reduce breathlessness and acute exacerbations 2, 4
- Inhaled long-acting antimuscarinic bronchodilators, such as tiotropium, have symptomatic efficacy in COPD, reducing dyspnea and acute exacerbations 2
- Combination of an antimuscarinic with an inhaled beta-2 agonist improves symptoms in 7% to 10% of patients 2
- Inhaled corticosteroids, such as beclomethasone, budesonide, or fluticasone, can be added to a long-acting beta-2 agonist to prevent exacerbations 2, 5, 6
Management of COPD Exacerbations
- Roflumilast, a potent and selective inhibitor of the enzyme phosphodiesterase-4, has been shown to reduce moderate to severe exacerbations in patients with severe COPD 3
- Formoterol, a highly selective and potent β2-agonist, relaxes airway smooth muscle to significantly improve lung function and reduce symptoms of COPD 4
- Combination therapy with a long-acting beta2-agonist and an inhaled corticosteroid appears to be effective in improving airway limitation after acute administration in patients with COPD 6