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. Inhaled drugs reduce exacerbations, improve symptoms, and slow decline; more recently, single-inhaler triple therapy has reported an all-cause mortality signal versus dual therapy in frequent exacerbators (IMPACT, a secondary-endpoint finding). ^{[1] [10]}

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References13ShowHide

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13. [13]Medical Research Council Working Party Long term domiciliary oxygen therapy in chronic hypoxic cor pulmonale complicating chronic bronchitis and emphysema. Report of the Medical Research Council Working Party Lancet, 1981.PMID 6110912