Feature Article

Mild COPD: initial steps. Common questions asked by primary care practitioners

Kerry Hancock, Peter Frith, Christine McDonald



Early implementation of evidence-based interventions in patients with mild chronic obstructive pulmonary disease (COPD) can improve outcomes for these patients. Questions often asked by GPs about the treatment of early and mild COPD are answered here.

Key Points

  • COPD is a clinical diagnosis confirmed by spirometric evidence of airflow limitation that is not fully reversible.
  • Early detection of COPD allows early intervention and the opportunity to improve outcomes.
  • Treatment of COPD is based on severity of symptoms, severity of airflow obstruction and presence or absence of exacerbations.
  • All smokers should be assisted to quit smoking.
  • All patients with COPD should be vaccinated against influenza, and referral to pulmonary rehabilitation should be considered, even for those with mild disease.
  • First-line pharmacotherapy for recently diagnosed mild COPD is a short-acting bronchodilator (reliever medication) on an as-needed basis. If symptoms persist or worsen, a long-acting bronchodilator may be added as maintenance therapy.
  • Long-acting bronchodilators (either alone or in combination with a second class of bronchodilator) have been shown to improve symptoms, help extend exercise tolerance and prevent exacerbations.
  • Comorbidities should be considered if symptoms of COPD outweigh objective findings.

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