Chronic obstructive pulmonary disease: management of chronic disease

Approximately 1.2 million people in the UK suffer from chronic obstructive pulmonary disease (COPD), leading to 115,000 unplanned hospital admissions per year. Smoking remains the leading cause (over 70% of cases) of COPD in high-income countries, but globally, especially in low-middle income countries only 30–40% of cases are attributed to smoking. COPD should be suspected among individuals with typical symptoms (dyspnoea, cough, wheeze, recurrent chest infections) but diagnosis requires confirmatory obstructive spirometry. Clinicians should aim to exclude alternative diagnoses, grade disease severity, personalize treatment and identify co-morbidities. The mainstays of COPD management are smoking cessation, vaccination, inhaled therapies and pulmonary rehabilitation. Therapy should particularly target symptom burden and exacerbation frequency. Recently developed interventional techniques and emerging evidence for the use of monoclonal antibody therapies appear promising. That said, the current frontier for improving outcomes might lie in a better understanding of disease trajectories, prompt diagnosis and earlier intervention to limit progressive lung function decline.