17. Treatment of COPD and alpha-1antitrypsin deficiency

Question 1

Main approach to COPD management

Answer 1

• Assess patient based on physical exam and patient history to assign to GOLD group, and for comorbidites like asthma that may influence treatment plan
• Provide non-pharmacological treatments to ALL patients of COPD
• Provide Pharmacological treatments according to GOLD group classifications
• Follow ups should include spirometry, proper inhaler technique review, noting exacerbation or worsening or treatment and changing management approach

Question 2

Non-pharmacological treatments for COPD

Answer 2

• Cessation of smoking is the single best lifestyle modification that not only prevents COPD but also slow the decline in already diagnosed COPD patients
• Physical activity to reduce risk of acute exacerbations
• Educate patients about workplace hazards, pollution and particles that can cause exacerbations
• Supportive care via immunizations [COPD can often be associated with increased risk of infections, Pneumococcus and Influenza vaccines]
• Manage comorbidities like depression, anxiety, osteoporosis screening, Lung cancer screening with low does CT regularly

Question 3

Pharmacological treatments for stable COPD

Answer 3

Number of Exacerbations < 1 without hospital admission:
- Low severity symptoms aka GOLD A [LABA/LAMA + SABA/SAMA]
- Higher severity symptoms aka GOLD B [LABA, LAMA combination therapy + SABA/SAMA]

Number of Exacerbations > 2 overall or > 1 with hospital management: [aka GOLD E]
- LABA, LAMA combination therapy
- OR if eosinophil count > 300 cells/mcL, consider LAMA, LABA, ICS triple therapy
- SABA/SAMA rescue medications

LABA - Long Acting Beta 2 Agonists
LAMA - Long Acting Muscarinic Antagonists
SABA - Short Acting Beat 2 Agonists
SAMA - Short Acting Muscarinic Antagonists

Question 4

Treatment options for Pesistent exacerbations post pharmacological therapy

Answer 4

• Macrolide antibiotics
• PDE4 inhibitors
• ICS or glucocorticoids
• Palliative pharmacotherapy for dyspnea [opiates]
• Methylxanthines [nonselective antagonize adenosine receptors and inhibit phosphodiesterase]
• Mucolytics [liquefy mucus by reducing disulfide bonds of mucoproteins]

Question 5

Management of advanced COPD

Answer 5

• Long term oxygen therapy
• Ventilation support [CPAP, NIPPV]

Invasive Therapy:
- Surgical bullectomy
- Lung volume reduction surgery
- Lung transplantation in very severe COPD

Question 6

Alpha-1 Antitrypsin Deficiency Treatment

Answer 6

• Purified AAT replacement [IV infusions of purified AAT derived from human plasma, to protect lungs from damage]
• Monitoring of LFTs and management of associated Liver Disease