This article outlines a treatment algorithm based on the latest guidelines and research for managing COPD, emphasising personalised care, and the latest therapeutic options and outlines a treatment algorithm to guide healthcare providers in the management of COPD.

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Chronic Obstructive Pulmonary Disease (COPD)

Chronic Obstructive Pulmonary Disease (COPD) is a progressive lung disease characterised by persistent respiratory symptoms and airflow limitation due to a variety of conditions, most commonly emphysema and chronic bronchitis. Effective management of COPD requires a comprehensive approach that includes pharmacological and non-pharmacological interventions.

Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of morbidity and mortality worldwide, characterised by an irreversible decline in lung function. According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD), COPD is primarily related to cigarette smoking, but other factors such as environmental pollutants and genetic conditions also contribute to the disease's progression [1].

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Treatment algorithm

Step 1: Diagnosis and assessment

Assessment begins with a thorough clinical history, physical examination, and spirometry to confirm airflow limitation (FEV1/FVC ratio < 0.70). Patients should also undergo assessments for symptoms using tools like the Modified British Medical Research Council (mMRC) scale or the COPD Assessment Test (CAT) [2].

Step 2: Classification of COPD severity

Based on spirometry and symptom evaluation, patients are classified as follows:

• Group A: Low symptoms, low exacerbation risk
• Group B: More symptoms, low exacerbation risk
• Group C: Low symptoms, high exacerbation risk
• Group D: More symptoms, high exacerbation risk [3].

Step 3: Initiating treatment

Group A: Low symptoms, Low exacerbation risk

Recommended treatment: Short-acting bronchodilator (SABA or SAMA) as needed.

Group B: More symptoms, Low exacerbation risk

Recommended treatment: Long-acting bronchodilator (LABA or LAMA) or combination therapy (LAMA+LABA).

Group C: Low symptoms, High exacerbation risk

Recommended treatment: LAMA, as it has shown efficacy in reducing exacerbations.

Group D: More symptoms, High exacerbation risk

Recommended treatment: LAMA + LABA combination. Consider inhaled corticosteroids (ICS) for patients with a history of frequent exacerbations.

Step 4: Management of exacerbations

1. First exacerbation: Treatment with oral corticosteroids and/or antibiotics depending on the severity of symptoms and presence of bacterial infection [4].
2. Frequent exacerbations: Consider a regular ICS or higher doses of LAMA/LABA.

Step 5: Non-pharmacological interventions

Regardless of the pharmacological treatment, non-pharmacological interventions should also be implemented:

1. Smoking cessation: The most crucial step in managing COPD symptoms and slowing disease progression [5].
2. Pulmonary rehabilitation: Comprehensive programs that include exercise training, education, and support [6]. 
3. Vaccinations: Annual influenza vaccines and pneumococcal vaccines to prevent infections.

Step 6: Long-term management and monitoring

1. Regular follow-up: Assessing control of symptoms, and updating treatment based on changes in symptoms or exacerbation rates.
2. Management of comorbid conditions: Address co-morbidities like cardiovascular disease, depression, and diabetes to enhance overall health status [7].

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Disclaimer- The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or position of M3 India.

About the author of this article: Dr Partha Ghosh, BNYS, MD(YS), is a general physician and a medical writer from Siliguri, Darjeeling.