HOW DO I HELP MY
PATIENTS TO BETTER
MANAGE THEIR COPD?

Prioritise self-management

It can be challenging for patients to know how to manage their COPD and adopt sustainable self-management skills. All patients should be given the tools and support to:

Quit smoking⁹
Maintain a healthy diet⁹
Exercise⁹
Understand the signs and symptoms of their disease⁹

In addition, patients with a higher risk of exacerbation should be encouraged to take part in a pulmonary rehabilitation programme.⁹

Adopt patient language

Many patients do not understand what COPD is, and more than half of patients are not familiar with words like “exacerbation”.³⁵ When discussing COPD with your patients, adopting a shared language and using terms such as “attack” or “flare-up” can help patients to understand what has happened to them.

Assess patient symptoms

During patient follow up visits, it is important to regularly talk with your patient about their symptoms, including any new or worsening ones as they are associated with an increased risk of exacerbations.^10,30

Use the flare-up checklist: talk to your patients about the importance of reporting exacerbations. You can help patients identify and report their COPD exacerbations by Downloading the Flare-up Checklist here.

Ensure up-to-date vaccination

Vaccines are an effective preventive measure in patients with respiratory diseases, including those with COPD. Despite this, their use in these patients is far from optimal.³⁸ Further optimisation of vaccination and antiviral treatment may improve the prognosis of individuals with chronic respiratory disease.³⁸

Specialists who treat adult patients with pulmonary disease should consider whether their patients’ vaccinations are up to date and to make every effort to ensure that preventive steps are taken. Discussing vaccination with patients and encouraging them to receive vaccines at their local pharmacies and or clinic (according to local regulations) or offering vaccination during consultation can improve vaccination rates.

Regularly review medications

Your patients may not pro-actively communicate changes to their symptoms during check-ups. New or worsening symptoms, and moderate or severe exacerbations, may necessitate a change in treatment.⁹ Conduct regular medication reviews to ensure patients are on the most appropriate therapy for them.

Tools to Help With COPD Treatment Optimisation

Initiation Algorithm (GOLD)

Proposed initial pharmacological treatments depending on COPD severity and frequency of exacerbations.

Download

Infographic of initial COPD pharmacological treatment: Group A—single bronchodilator; Group B—LABA+LAMA; Group E—LABA+LAMA, consider adding ICS if blood eosinophils ≥300; grouping informed by exacerbation history and symptom scales (mMRC, CAT).

Follow Up Algorithm (GOLD)

Proposed follow up pharmacological treatment following dyspnoea or COPD exacerbation

Download

Flowchart of follow up pharmacological treatment for COPD: separate pathways for dyspnea and exacerbations recommend LABA or LAMA, escalate to LABA+LAMA, and consider add ons (ICS for high eosinophils; roflumilast, azithromycin, dupilumab in selected patients).

Proposed Patient Discharge Protocol

Proposed hospital discharge protocol form following severe COPD exacerbation

Download

It’s never too early to Act on COPD

Put prevention of exacerbation and early death at the centre of COPD management.

American Lung Foundation. Heart-Lung Relationship. Blog, February 13, 2023. https://www.lung.org/blog/heart-lung-relationship
Watz H, et al. Respir Res 2018;19:251
Suissa S, et al. Thorax 2012;67:957–963
Donaldson GC, et al. Chest 2010;137:1091–1097
Kunisaki KM, et al. Am J Respir Crit Care Med 2018;198:51–57
Rothnie KJ, et al. Am J Respir Crit Care Med 2018;198:464–471
Hurst JR, et al. Eur J Int Med 2020;73:1–6
Pullen R, et al. Int J Chron Obstruct Pulmon Dis 2021;16:2301–2322
Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for prevention, diagnosis and management of COPD. 2025. https://goldcopd.org/2025-gold-report/ (Accessed July 2025)
Müllerová H, et al. BMJ Open 2014;4:e006171
Hughes R, et al. Respir Med 2022;200:106921
Singh D, et al. Int J Chron Obstruct Pulmon Dis 2021;16:3009–3016
Barnes N, et al. BMC Pulm Med 2013;13:54
Pavord ID, et al. Int J Chron Obstruct Pulmon Dis 2016;11(special issue):21–30
Graul EL, et al. Am J Respir Crit Care Med 2023; doi: 10.1164/rccm.202307-1122OC (Epub ahead of print, Dec 21)
Adeloye D, et al. Lancet Respir Med 2022;10:447–458
Hurst JR, et al. N Engl J Med 2010;363(12):1128–1138
ClinicalTrials.gov. NCT00292552. Accessed March 2024
Wallace AE, et al. J Manag Care Spec Pharm 2019;25(2):205–217
Koblizek V, et al. Eur Respir J 2017;49(5):1601446
Jones PW, et al. Am J Respir Crit Care Med 2015;191:A2532
Matsunaga K, et al. Respir Investig 2015;53(2):82–85
Hoogendoorn M, et al. Int J Chron Obstruct Pulmon Dis 2017;12:3183–3194
Tashkin DP, et al. N Engl J Med 2008;359(15):1543–1554
Roche N, et al. Eur Respir J 2017;50:OA1487
Kania A, et al. Int J Chron Obstruct Pulmon Dis 2018;13:1613–1621
Halpin DMG, et al. Respir Med 2017;128:85–91
Rothnie KJ, et al. Ann Am Thorac Soc 2018;15(8):935–946. doi: 10.1513/AnnalsATS.201710-815OC
Mannino DM, et al. Respir Med 2006;100:115–122
Hughes R, et al. Respir Med 2022;200:106921
Bafadhel M, et al. Lancet Respir Med 2018;6:117–126
Lindberg A, et al. Respir Med 2015;109:88–95
Dransfield MT, et al. Am J Respir Crit Care Med 2017;195(3):324–330
Westerik JAM, et al. Respir Res 2017;18:31
Kessler R, et al. CHEST 2006;130(1):133–142
Wedzicha JA, Mackay AJ, Singh R. COPD exacerbations: impact and prevention. Breathe 2013;9(6):434–440
Ji Z, Jareño-Esteban JJ, de Miguel-Díez J. Role of Vaccines in COPD Patients. Open Respir Arch 2022;4(3):100191
Simon S, Joean O, Welte T, Rademacher J. The role of vaccination in COPD: influenza, SARS-CoV-2, pneumococcus, pertussis, RSV and varicella zoster virus. Eur Respir Rev 2023;32(169)
Hogea S-P, Tudorache E, Fildan AP, Fira-Mladinescu O, Marc M, Oancea C. Risk factors of chronic obstructive pulmonary disease exacerbations. Clin Respir J 2020;14:183–197
Linden D, Guo-Parke H, Coyle PV, Fairley D, McAuley DF, Taggart CC, Kidney J. Respiratory viral infection: a potential "missing link" in the pathogenesis of COPD. Eur Respir Rev 2019;28(151):180063
Papi A, Bellettato CM, Braccioni F, Romagnoli M, Casolari P, Caramori G, Fabbri LM, Johnston SL. Infections and airway inflammation in chronic obstructive pulmonary disease severe exacerbations. Am J Respir Crit Care Med 2006;173(10):1114–1121. doi: 10.1164/rccm.200506-859OC
Bouquet J, Tabor DE, Silver JS, Nair V, Tovchigrechko A, Griffin MP, et al. Microbial burden and viral exacerbations in a longitudinal multicenter COPD cohort. Respir Res 2020;21:1–13. doi: 10.1186/s12931-020-01340-0
Mathioudakis AG, Janssens W, Sivapalan P, Singanayagam A, Dransfield MT, Jensen J-US, et al. Acute exacerbations of chronic obstructive pulmonary disease: in search of diagnostic biomarkers and treatable traits. Thorax 2020;75(6):520–527
Frickmann H, Jungblut S, Hirche TO, Groß U, Kuhns M, Zautner AE. The influence of virus infections on the course of COPD. Eur J Microbiol Immunol (Bp) 2012;2(3):176–185. doi: 10.1556/EuJMI.2.2012.3.2
Dimopoulos G, Lerikou M, Tsiodras S, Chranioti A, Perros E, Anagnostopoulou U, Armaganidis A, Karakitsos P. Viral epidemiology of acute exacerbations of chronic obstructive pulmonary disease. Pulm Pharmacol Ther 2012;25(1):12–18. doi: 10.1016/j.pupt.2011.08.004
Bafadhel M, McKenna S, Terry S, et al. Acute exacerbations of chronic obstructive pulmonary disease: identification of biologic clusters and their biomarkers. Am J Respir Crit Care Med 2011;184(6):662–671
Aaron SD, Donaldson GC, Whitmore GA, Hurst JR, Ramsay T, Wedzicha JA. Time course and pattern of COPD exacerbation onset. Thorax 2012;67(3):238–243
Wilkinson TM, Hurst JR, Perera WR, Wilks M, Donaldson GC, Wedzicha JA. Effect of interactions between lower airway bacterial and rhinoviral infection in exacerbations of COPD. Chest 2006;129(2):317–324
Falsey AR, Walsh EE, Esser MT, Shoemaker K, Yu L, Griffin MP. Respiratory syncytial virus-associated illness in adults with advanced chronic obstructive pulmonary disease and/or congestive heart failure. J Med Virol 2019;91:65–71
Sethi S, Murphy TF. Infection in the pathogenesis and course of chronic obstructive pulmonary disease. N Engl J Med 2008;359:2355–2365

^* In some patients, lung function did not recover to pre-exacerbation levels by eight weeks after the start of the moderate exacerbation

^†Following a severe exacerbation, the rate of severe exacerbation increased and the time to subsequent exacerbations decreased

^‡Singh D, Han MK, Hawkins NM, et al. Implications of Cardiopulmonary Risk for the Management of COPD: A Narrative Review. Adv Ther (2024). https://doi.org/10.1007/s12325-024-02855-4

^**In a study conducted on patients with moderately severe COPD and rigorously adjudicated CVD events

^***Cohort study evaluating severe COPD exacerbations and their association with mortality in 73,106 patients with their first severe COPD exacerbation requiring hospitalisation (patients identified 1990–2005, followed until death or 31 March 2007)

^****Irreversibly reduce lung function

^*****The relative risk of MI returned to near baseline, similar to any other post-exacerbation time interval

Welcome to AZMedical Science

HOW DO I HELP MY PATIENTS TO BETTER MANAGE THEIR COPD?

Prioritise self-management

Adopt patient language

Assess patient symptoms

Ensure up-to-date vaccination

Regularly review medications

Tools to Help With COPD Treatment Optimisation

Initiation Algorithm (GOLD)

Follow Up Algorithm (GOLD)

Proposed Patient Discharge Protocol

It’s never too early to Act on COPD

Put prevention of exacerbation and early death at the centre of COPD management.

References

HOW DO I HELP MY
PATIENTS TO BETTER
MANAGE THEIR COPD?