Chronic Obstructive Pulmonary Disease

The answer first

COPD is a common, preventable and treatable disease characterised by persistent respiratory symptoms and airflow limitation caused by airway and alveolar abnormalities, usually driven by significant exposure to noxious particles or gases — overwhelmingly tobacco smoke. The diagnosis is confirmed by spirometry: a post-bronchodilator FEV1/FVC ratio less than 0.70. ^[1]

Two facts must land before everything else: ^[1]

1. COPD is not asthma. Inhaled corticosteroids (ICS) are not first-line monotherapy in COPD. The cornerstone of pharmacotherapy is bronchodilation — a long-acting muscarinic antagonist (LAMA) and/or long-acting beta-agonist (LABA). ICS is added only when exacerbations persist despite dual bronchodilation, and its use carries a real pneumonia risk.
2. Exacerbations drive mortality and decline. A hospital admission for an exacerbation marks a step-change in the disease trajectory. Preventing exacerbations — through bronchodilation, smoking cessation, vaccination, pulmonary rehabilitation, and oxygen where indicated — is the central goal of long-term management. ^[1]

The two interventions with proven mortality benefit are smoking cessation and long-term oxygen therapy (LTOT) for severe chronic hypoxaemia. No inhaled drug has convincingly reduced all-cause mortality — but they reduce exacerbations, improve symptoms, and slow decline. ^[1]

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References12ShowHide

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