Principles of prescribing | Right Decisions

Removal or reduction of risk factors, such as stopping smoking is the first step to management of COPD.
Breathlessness in COPD is managed with long-acting bronchodilation. GOLD⁴⁷ and NICE guidance recommend dual bronchodilation, although in clinical practice often single agent long-acting bronchodilation is used. Prescribers should be guided by local formulary guidance.
Inhaled therapy aims to relieve the symptoms of breathlessness in COPD.
Pharmacotherapy can reduce COPD symptoms, reduce the frequency and severity of exacerbations, and improve health and exercise tolerance.⁴⁷
Patients with COPD should be reviewed regularly to ensure that treatment is optimised.
Inhaler device selection is important, and patients should receive training in how to use the device and be able to use it. Sufficient inspiratory flow is needed for a dry powder inhaler (DPI) and if an individual can breathe in quickly and deeply over two to three seconds, they are likely to be able to manage a DPI. Those who are frail, elderly or the very young are less likely to have sufficient inspiratory flow and an MDI with spacer may be more appropriate.
Environmental impact of inhalers is a key consideration and prescribers are asked to consider inhalers with a lower global warming potential where it is appropriate for the patient (see Environmental impact of inhalers).
To prescribe most effectively for individuals with COPD the ‘what matters to you?’ principles and Polypharmacy 7-Steps approach are recommended.