Treatment of Stable Chronic Obstructive Pulmonary Disease (COPD)

Maintaining Optimal Health in Stable Chronic Obstructive Pulmonary Disease (COPD)

Smoking Cessation

Cigarette smoking is recognized as the single most important risk factor for chrnonic obstructive pulmonary disease (COPD). In the United States, about 80% of people with COPD are either current or former smokers. Smoking cessation is currently the only intervention that is known to slow down the progression of COPD and patients who quit smoking can reduce their rate of lung function decline by up to 50%. It is, therefore, of paramount importance to develop and implement a smoking cessation program for all COPD patients who are current smokers.

Treatment options for smoking cessation include:

  • Behavioural counseling (e.g., cognitive-behavioral therapy)
  • Nicotine replacement therapy
    • transdermal nicotine systems (nicotine patches)
    • nicotine polacrilex (nicotine chewing gum)
    • nicotine inhaler or nicotine nasal spray
  • Antidepressant medications
    • bupropion (Wellbutrin) - this antidepressant medication has been shown to be effective for smoking cessation, including in patients with COPD
    • nortriptylene (Pamelor; Aventyl) - this antidepressant medication is considered to be a second-line medication for smoking cessation

Prevention of Infection

Many people with COPD are elderly and are, therefore, particularly susceptible to viral infections (e.g., influenza) and bacterial infections (e.g., pneumonia). Influenza vaccination ("flu" vaccine) has been shown to reduce serious illness and mortality in people with COPD by up to 50% and, therefore, most experts recommend annual influenza vaccination for COPD patients. Many experts also recommend pneumococcal vaccination (Pneumovax) for people with COPD to reduce the risk of developing pneumonia.

Antibiotics

The routine use of prophylactic antibiotics to prevent infections in people with stable COPD before they occur is not recommended because of serious concerns for promoting the emergence of antibiotic-resistant strains of bacteria. Antibiotics are, therefore, usually reserved for patients who experience acute exacerbations (flare-ups) of COPD.