Early diagnosis of COPD and getting a management plan in place quickly are incredibly important as they can slow the progression of the disease. There is no cure for COPD, so instead treatment focuses on controlling symptoms in order to improve quality of life, and reducing the frequency and severity of exacerbations. It is also crucial to revisit the management plan at regular intervals as a long-term decline in lung function is inevitable, and so what has been working well at one point in time is likely to need adjusting later in order to keep symptoms in check.

There are several different treatment options used to manage COPD, including the following:

• Inhaled bronchodilators are used in the first instance to reduce breathlessness and improve exercise tolerance. A short-acting agent such as salbutamol, terbutaline or ipratropium can be used to relieve symptoms on a ‘when required’ basis, but if it is needed frequently, or the patient is experiencing recurrent exacerbations, a regular long-acting bronchodilator such as salmeterol, formeterol or tiotropium should be introduced. In severe cases, bronchodilators may need to be administered via a nebuliser.

• Inhaled corticosteroids may be added to long-acting bronchodilator therapy if the patient continues to experience breathlessness or exacerbations. Note that they should not be used on their own in COPD – this is where combination inhalers really come into their own – and the doses used for this condition are usually higher than is the case for asthma.

• Aminophylline/theophylline is sometimes used if someone with stable COPD cannot use inhalers very well, or still has symptoms despite using them correctly. However, these drugs have a high chance of causing side effects so need careful monitoring.

• Mucolytics, which break down phlegm and make it easier to bring up from the airways, have a place for patients with stable COPD and a chronic productive cough.

• Oral corticosteroids may become necessary during an exacerbation, and patients with severe COPD may have a rescue course prescribed for them to use if necessary.

• Antibiotics may be used if purulent sputum or other signs of infection are present. Again, individuals may be prescribed a rescue course that they can start without having to first make a doctor’s appointment if their condition is considered serious enough to warrant it.

• Oxygen is often used if blood levels drop during an acute exacerbation, and may be administered on a long-term basis at home under certain circumstances.

Regular check-ups are essential for COPD patients; once a year if their condition is relatively mild and well controlled, and at least twice a year for more severe cases. At reviews, several tests should be performed, including spirometry, body mass index and evaluation of symptoms, any side effects of drug treatment, inhaler technique, and any complications they might have, which can include issues such as depression and anxiety, as well as other respiratory problems.