COPD Diagnosis and Treatment: Getting a proper diagnosis for COPD is crucial. Despite its commonality, many people are not diagnosed until it has reached an advanced stage.
COPD Diagnosis and Treatment
During the initial consultation, your doctor will discuss your symptoms, family history, and exposure to irritants in the air. Various tests are often ordered to confirm the diagnosis. In addition to an Arterial blood gas analysis, your doctor may also recommend the use of glucocorticoids or bronchodilators.
Arterial blood gas analysis
The purpose of arterial blood gas analysis for COPD diagnosis and treatment is to measure the acid-base balance of the patient’s blood. Blood pH values typically range from 7.35 to 7.45. Lower or higher values are considered too acidic or too basic. Arterial blood gas analysis is used in the care of people before and after surgery, as well as during intensive care and pain medicine. The average patient has an arterial blood gas analysis performed once a year.
Acute COPD patients are often diagnosed with respiratory insufficiency through arterial blood gas analysis in the emergency department (ED). Although this test has limited predictive value, it is widely used in the clinical workup of several dyspnea-related diseases, including asthma, COPD, and CHF. Several studies have examined the value of arterial blood gas analysis in PE. However, some have questioned the value of prediction rules based on the ABGA. In an attempt to determine the utility of ABGA in PE, Levin et al. assessed factors associated with ABGA and community-acquired pneumonia.
In general, arterial blood gas analysis is an important diagnostic test that determines the oxygen and carbon dioxide levels in a patient’s blood. The test helps determine the severity of lung disease and helps determine whether a patient’s treatment is effective. Arterial blood gas analysis results can be abnormal and can indicate a respiratory disorder. However, this test does not reveal whether COPD is a chronic or acute disease.
While arterial blood gas analysis is essential in the diagnosis and management of COPD, it is not the only way to make sure the disease is under control. If the patient requires domiciliary oxygen therapy, pulmonary hypertension, or is experiencing breathlessness that is out of proportion to their clinical state, then ABGA may be necessary. PaO2 levels should be within normal ranges.
Pulmonary computed tomography
While pulmonary computed tomography is not the only way to diagnose COPD, it is considered to be a gold standard. Early stage COPD usually has relatively normal lung function and is characterized by small changes in the airways. The discovery of the silent zone where disease accumulates led to the development of specialized physiological tests to detect these changes early on and intervene in the progression of the disease.
The imaging technique has many benefits. It is very sensitive, allowing the physician to see the structure of lung tissue. It can also reveal different states of the disease among patients. This imaging technique is useful for determining the exact nature of COPD and individualized treatment. Here are some examples of how pulmonary CT is used for COPD diagnosis. To learn more about lung CT, contact us today.
CT images can reveal different compositions of COPD based on the ventilation mode. These images allow physicians to determine the etiology of the disease. CT images are divided into three major types: diffuse emphysema, pulmonary hypertension, and atrophic emphysema. The CT scans can be used to define homogeneous sub-groups of COPD patients and as a biomarker of disease progression. However, the imaging technology has limitations that must be overcome before it can become widely adopted for COPD diagnosis and treatment.
CSA is a quantitative CT imaging technique that has been extensively studied for lung disease. CSA provides a direct comparison of pulmonary vascular anatomy, with increased heterogeneity in smokers. CSA also helps in the evaluation of sub-segmental pulmonary vessels. Lastly, it is useful for the diagnosis of emphysema. It provides the most accurate diagnosis of COPD.
Bronchodilators
Bronchodilators are the primary pharmacological interventions for COPD. These medications increase airflow and gaseous exchange and reverse the effects of dynamic lung hyperinflation. These drugs also help dilate the distal airways. Depending on the drug used, these drugs can have different mechanisms of action. Muscarinic antagonists inhibit acetylcholine at muscarinic receptors, while b2-adrenoceptor agonists enhance cAMP signalling by binding to b2-adrenoreceptors.
The primary treatment for COPD is long-acting bronchodilators, which are commonly prescribed for all three GOLD groups. For patients with GOLD B, LAMA/LABA dual bronchodilator therapy may be used. For patients with GOLD C and D, therapy may include inhaled corticosteroid and LABA/LABA combination therapies. The combination of LAMA/LABA is also common in COPD therapy.
Inhaled bronchodilators may cause side effects, such as nausea and vomiting. These side effects usually subside after a couple of weeks. However, if you experience any serious side effects while on beta-2 agonists, contact your doctor immediately. Although COPD has no cure, a combination of inhaled bronchodilators can be helpful in determining the best treatment.
A fixed combination of ultra LABA and LAMA is a better option than the use of individual bronchodilators. This will provide more consistent bronchodilation, and minimize fluctuations in the calibre of the bronchioles. This combination is also known to reduce COPD exacerbation risk. This combination can be prescribed for people with severe COPD. This combination should be considered if the disease is resistant to bronchodilator therapy.
Glucocorticoids
Glucocorticoids for COPD diagnosis and treatment are considered to be effective for the treatment of moderate-to-severe COPD and are associated with good clinical outcomes. Compared to placebo, glucocorticoids may be associated with good clinical outcomes in AECOPD patients, but their effectiveness in COPD patients is uncertain. The primary outcome of the study was the number of exacerbations and hospitalizations related to COPD. Other secondary outcomes included treatment costs, hospital stay, and COPD-related readmissions.
Currently, most guidelines recommend a seven to fourteen-day course of systemic glucocorticoids for acute exacerbations of COPD. However, the optimal dose and duration for this treatment remain unclear. A recent study demonstrated that short-term (5-day) glucocorticoids are noninferior to 14-day treatment while significantly reducing exposure to steroids. This study was called the REDUCE trial. It enrolled 314 patients with COPD and was conducted in five teaching hospitals in Switzerland. It enrolled a controlled group of patients with a history of smoking but no history of asthma.
Corticosteroids suppress inflammation by inhibiting transcription of several genes. Glucocorticoids have major anti-inflammatory effects by inhibiting the action of several mitogen-activated protein kinases, including c-Jun N-terminal kinase and extracellular signal-regulated kinase. In addition, they inhibit the interaction of activated GR with transcription factors. Therefore, the inhibition of single transcription factor may only modify the full response. Glucocorticoids also reduce the activity of downstream targets of transcription factor activation.
Efficacy of systemic corticosteroids in COPD exacerbations was studied in a randomized controlled trial comparing short-term (5 days) to long-term (14 days) corticosteroid therapy. The study enrolled 314 consecutive patients with COPD and an exacerbation defined by change in sputum volume, dyspnea, cough, and purulence.
Electrical stimulation
A six-week home-based neuromuscular electrical stimulation (NMES) programme improved skeletal muscle strength and endurance. The improved muscle function was associated with reduced breathlessness during activities of daily living. These findings are preliminary and need further investigation in larger randomized controlled trials. Nonetheless, this technique has potential for improvement of COPD patients’ quality of life and overall health. A number of preliminary results suggest that NMES could improve patients’ quality of life and help them maintain or improve their lung function.
Aside from improving respiratory symptoms, electrical stimulation has many other applications, including strengthening muscles. The electrodes are placed on the skin and small electrical impulses are sent to weak muscles to improve their strength and function. A second treatment option involves pulmonary rehabilitation, which can improve symptoms associated with COPD. Nebulised medicines may be used in more severe cases. If an individual is suffering from severe COPD symptoms, they may need additional treatment.
The study group included thirty consecutive COPD patients. Patients were diagnosed with COPD using the GOLD criteria, or the Global Initiative for Chronic Obstructive Lung Disease (GOLD) score, which is a combination of FEV1 and force-defined vital capacity. In addition, they all experienced chronic breathlessness, and none of the patients had previously participated in pulmonary rehabilitation. If you are interested in learning more about COPD, you can read our recent article.
The current trial used an NMES training protocol that included written instructions for patients to follow at home. The patients were instructed to increase the amplitude of the stimulation until they felt comfortable and there was no pain. In addition, participants completed a self-report diary. Once a week, the physiotherapist responsible for training visited the patients at home to check compliance. Patients also provided feedback regarding the week before the study began.