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COPD POEMs
Patient Oriented Evidence that Matters

Introduction COPD POEM PDF
Summary
The COPDX Plan
Confirm diagnosis & assess severity
Optimise function
Prevent deterioration
Develop support network & self-management plan
eXacerbations manage appropriately
Review of drug use in COPD
Appendix One - Resources and contacts
References

Summary

Treatment for those with COPD can be improved by adoption of the COPDX plan (see page 3). The following actions are critical to the success of the plan:

1. Earlier diagnosis for those with COPD
Steps to earlier diagnosis include identifying all smokers enrolled with the practice, screening them ideally with spirometry or possibly PEFR and using spirometry to ensure an accurate diagnosis.
2. Increased use of the combined approach of nicotine replacement therapy (NRT) and smoking cessation programmes for smokers
Smoking cessation is the only intervention shown to halt the accelerated decline in lung function seen in COPD. This combined approach to smoking cessation has proven effectiveness.
3. Limitation of the inappropriate use of steroids (inhaled and oral) by those with COPD
Oral steroids are useful only in the management of COPD exacerbations. Inhaled steroids have a very limited role and are not approved for use in COPD in many countries.
4. Use of a stepped regime of bronchodilator therapy for those with COPD
A suitable stepped regime is one such as:
  1. Intermittent inhaled short acting beta-2 agonist.
  2. Addition of regular combined short acting beta-2 agonist plus ipratropium.
  3. Tiotropium for severe COPD.
5. Appropriate use of antibiotics in the treatment of COPD
Antibiotics are only useful in exacerbations with evidence of bacterial infection.
Prophylactic therapy is not helpful.
6. Increased uptake of annual influenza and five-yearly pneumococcal vaccination by those with COPD
The strongest evidence is for influenza immunisation, although pneumococcal immunisation is likely to be beneficial.
7. Increased use of pulmonary rehabilitation in the treatment of those with moderate to severe COPD
Pulmonary rehabilitation should be offered to all those with moderate or severe COPD.

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