Chronic stable disease - non drug therapy

Treatment of chronic stable COPD aims to prevent exacerbations and improve physical function through drug therapy in combination with appropriate non drug therapy such as O₂ therapy, smoking cessation, exercise, enhancement of nutrition, and pulmonary rehabilitation. Surgical treatment of COPD is indicated for selected patients.

Oxygen therapy

Long-term oxygen (O₂) therapy is recommended for patients with severe resting hypoxaemia. The primary goal is to increase the baseline arterial oxygen [PaO₂ to at least 60 mmHg] and/or produce a haemoglobin O₂ saturation (SaO₂) of at least 88–92%. It has been shown to prolong life in COPD patients with severe resting hypoxaemia.¹ 

Pulmonary rehabilitation

Pulmonary rehabilitation programmes serve as adjuncts to drug treatment to improve physical function and many hospitals and healthcare organizations offer formal multidisciplinary rehabilitation programmes. Pulmonary rehabilitation should be individualized and includes exercise, smoking cessation, nutrition counselling, education, and behavioural intervention.¹ The benefits of rehabilitation are greater independence and improved quality of life and exercise capacity.

Surgery

Surgical options for treatment of severe COPD include lung volume reduction and transplantation.

Lung volume reduction surgery (LVRS) involves resection of parts of the lung to reduce hyperinflation, making respiratory muscles more effective. LVRS also improves the elastic recoil pressure of the lung, improving expiratory flow rates and reducing exacerbations. However, LVRS has been shown to result in higher mortality than medical management in certain patient groups.¹ Occasionally, patients have extremely large bullae that compress the functional lung. These patients can be helped by surgical resection of these bullae, with resulting relief of symptoms and improved pulmonary function.

Candidates selected for lung transplantation include patients with very severe COPD. The goal of lung transplantation is to improve quality of life and functional capacity. Lifelong immunosuppression is required, with the attendant risk of opportunistic infections. Lung transplantation is limited by the shortage of donor organs and cost.

Reference

1. Global Initiative for chronic obstructive lung disease: Global strategy for the diagnosis, management, and prevention of COPD. 2011. www.goldcopd.org