COPD treatments have changed – has yours?
Respiratory Treatments for chronic obstructive pulmonary disease (COPD) have evolved, so patients should check that they are getting the right one.
Too many of Ireland's COPD patients end up in hospital too often. Figures from 2016 show that Ireland had the highest rate of hospitalisations due to COPD of all OECD countries1, at 389 per 100,000 people.
"COPD is the most common cause of adult emergency hospital admissions in Ireland."
“There is a National Clinical Programme which, amongst other things, is addressing this issue,” says Professor Stephen Lane, Consultant Respiratory Physician at Tallaght hospital and Peamount Healthcare. Smoking is the cause of COPD, which is the commonest cause of adult emergency hospital admissions in Ireland, usually resulting from exacerbations, when symptoms of cough, breathlessness and wheeze worsen.
If you think you have COPD, Lane says: “Discuss with your GP and ask for a diagnostic spirometry [breathing] test.”
Letting patients know about new COPD treatments could reduce hospitalisations,as better and earlier treatment could reduce exacerbations.
In the past, inhaled corticosteroids (ICS) were used to treat COPD first line, but this is no longer recommended. “Inhaled steroids do not reduce mortality in COPD patients and there is an increased rate of pneumonia in patients who use them,” says Lane.
The main treatment for COPD is smoking cessation.
Lane says: “Ask your doctors for help in giving up. Nicotine replacement products and drugs such as varenicline help in smoking cessation. E-cigarettes are controversial but I consider them a help.”
"Stop smoking, get a flu jab and pneumococcal vaccination."
As a second line of defence, people with COPD should get an annual flu jab and a pneumococcal vaccination to reduce the risk of exacerbations
Inhaled drugs are also very beneficial. New international guidelines for the treatment of COPD recommend bronchodilators, initially a long-acting muscarinic antagonist (LAMA). If necessary a long-acting β-agonist (LABA) can be added. For moderate to severe cases, both are commonly packaged together for optimum bronchodilation. Steroids should generally be avoided but do still have role in patients with severe disease who are still exacerbating.
Cutting the toll
A 2016 trial showed that a fixed-dose combination of LABAs and LAMAs, when used in an exacerbating population with moderate to severe COPD, reduced exacerbations by 19%, compared to patients using a combination of LABAs and ICS. Fewer exacerbations could mean fewer hospitalisations.
The HSE National Clinical Programme for COPD aims to reduce hospital admissions by 1,500 a year by improving access to spirometry for earlier diagnoses and providing pulmonary rehabilitation for symptomatic patients.
Patients can act to help themselves. Lane says: “COPD therapies are changing so ask your GP for an annual review to ensure you are getting the right treatment.”
1 The Organisation for Economic Co-operation and Development is an intergovernmental economic organisation with 35 member countries, founded in 1960 to stimulate economic progress and world trade.