Classification of COPD Severity:
Classification of COPD Severity Clinical Practice Guidelines Management of Chronic Obstructive Pulmonary Disease, Revised November 2009
Respiratory function tests:
Respiratory function tests Airflow limitation FEV1:FVC < 75% Restrictive lung disease FEV1:FVC >75%
Clinical Differences Between Asthma and COPD:
Clinical Differences Between Asthma and COPD
Inhaled corticosteroids (ICS) :
Inhaled corticosteroids (ICS) long-acting β2-agonists (LABAs) and long-acting anticholinergics (LAACs)
Inhaled LABA and inhaled corticosteroid (ICS) combination:
Inhaled LABA and inhaled corticosteroid (ICS) combination The combination of LABA/ICS has been shown to improve lung function, quality of life and reduce exacerbations compared with placebo in COPD patients with FEV1 < 65% predicted. In the TORCH study, there was a trend towards a reduction in mortality in patients taking LABA/ICS compared to placebo, though the reduction was not statistically significant. In the same study, the decline in lung function in the patients taking LABA/ICS (39 mL /year) was also slowercompared with placebo (55 mL /year). TORCH ( TOwards a Revolution in COPD Health)
Inhaled LAAC and inhaled LABA/ICS combination:
Inhaled LAAC and inhaled LABA/ICS combination In the UPLIFT study, where 53% of the study patients had severe to very severe COPD and 46% of them were on ICS/LABA, the addition of tiotropium was associated with a significant improvement in lung function, a significant delay in time to first exacerbation, significant reduction in number of exacerbations and significant improvement in health-related quality of life. UPLIFT (Understanding Potential Long-term Impacts on Function with Tiotropium )
Inhaled corticosteroids (ICS) Monotheraphy:
Inhaled corticosteroids (ICS) Monotheraphy The EUROSCOP trial and the Copenhagen Lung Health Study showed the use of ICS in mild COPD does not slow the rate of decline of FEV1. However , the ISOLDE trial and and the study by Paggiarro PLet al showed that treatment with high dose ICS, in this case, fluticasone 1000 μg a day, in moderate to severe COPD decreases exacerbations and modestly slows the progression of respiratory symptoms, but has minimal or no impact on lung function. Two recent multi-centre randomised controlled studies confirmed that ICS alone improves FEV1 and health-related quality of life, and reduces moderate to severe exacerbations . Furthermore , the TORCH study showed a slower rate of decline in lung function in patients taking high dose ICS alone (42 mL /year) as compared with placebo (55 mL /year ). EUROSCOP (European Respiratory Society Study on Chronic Obstructive Pulmonary Disease) The Inhaled Steroids in Obstructive Lung Disease (ISOLDE)