Inhaled therapy for chronic obstructive pulmonary disease
Chronic obstructive pulmonary disease is characterised by progressive symptoms of productive cough, breathlessness, wheeze and exacerbations. Airway obstruction is detected by quality assured spirometry, and is defined as a Forced Expired Volume in one second / Forced Vital Capacity ratio <0.7. Inhaled therapy is the most effective treatment solution, with bronchodilators and inhaled steroids helping to improve symptoms, quality of life and lung function, while reducing risk of exacerbations. Bronchodilators are available as both monotherapy and as dual combination therapy. Inhaled steroids can be added to inhaled long-acting bronchodilators, but are not without significant complications, including pneumonia. Therefore, careful assessment of the phenotype of a patient with chronic obstructive pulmonary disease must be given before commencing any therapy that contains inhaled steroid and other treatments, such as flu vaccination, smoking cessation and pulmonary rehabilitation should be given due consideration.
Airflow obstruction may be caused by bronchoconstriction and an abnormal inflammatory response, often the result of prolonged inhalation of noxious particles, such as through smoking. Overproduction of mucus is seen in chronic bronchitis, and permanent damage to lung tissue can be found in emphysema (McNee, 2006). Symptoms include progressive and persistent shortness of breath that is made worse with activity, a chronic cough that may be intermittent, regular sputum production, and wheezing (National Institute for Health and Care Excellence (NICE), 2019). Respiratory tract infections are common and can lead to exacerbations or attacks that can last days of even weeks, and often result in a decline in lung function (Global Initiative for Chronic Obstructive Lung Disease (GOLD), 2020). The aims of treatment strategies include reduction of disease progression, improving symptoms and quality of life, maintaining lung function, and reducing risk of exacerbation (NICE, 2019; GOLD, 2020).
Register now to continue reading
Thank you for visiting Journal of Prescribing Practice and reading some of our peer-reviewed resources for prescribing professionals. To read more, please register today. You’ll enjoy the following great benefits:
Limited access to our clinical or professional articles
New content and clinical newsletter updates each month