Symptoms Not Spirometry Should Drive COPD Treatment

Treatment decisions in chronic obstructive pulmonary disease (COPD) should be driven by the patient's symptoms (such as dyspnea) and not by the classic spirometry measure of forced expiratory volume (FEV₁), said Sanjay Sethi, MD. "FEV₁ is essential in diagnosing COPD but it does not correlate well to a patient's symptoms and quality of life. Patients only care about their symptoms. Our clinical decisions about therapy should reflect that," said Dr. Sethi, associate professor of pulmonary, critical care and sleep medicine, University of Buffalo (NY).

The measurement tools that help clinicians evaluate their COPD patients' symptoms and therapeutic needs include quality of life and dyspnea indices; exercise testing; exacerbations; and hospitalizations.

The treatment of COPD relies on a "step-wise approach", with therapies being added if symptoms such as cough, dyspnea, and exacerbations persist or worsen, said Sethi. Patients with mild disease should receive annual influenza vaccination and use a short-acting bronchodilator. A patient with moderate disease should have a long-acting bronchodilator added and should enter pulmonary rehabilitation. If symptoms persist, then two long-acting bronchodilators (beta-agonists and anticholinergics) should be used. If symptoms continue, then either inhaled corticosteroids should be added (in the case of frequent exacerbations or bronchitis) or theophylline should be added (for dyspnea). Oral corticosteroids can be used as a last resort.