Asthma and COPD Management
1Emergency Medicine, Woodlands Health Campus, Singapore
Asthma and chronic obstructive pulmonary disease (COPD) are the leading chronic respiratory diseases presenting to the emergency department. If not treated adequately, the cost of asthma care is high, not only for its treatment but mainly due to costs related to the loss of productivity. By 2030, COPD is expected to represent the third leading cause of death in middle-income countries and would also account for a significant proportion of healthcare budgets, secondary to hospitalizations for exacerbations.
Identification and immediate care of these patients, especially their acute exacerbations, is critical. Advances in management of these conditions have led to a significant improvement in strategies to treat these patients. Early effective and prolonged bronchodilation can slow disease progression and reduce the frequency of exacerbations.
With regard to asthma, after treating the acute exacerbation, inhaled corticosteroids (ICS), alone or in combination with long-acting β2-agonists (LABAs), remain the cornerstone of pharmacologic treatment. New perspectives include the use of biologic therapy and bronchial thermoplasty for asthmatic patients. Improved identification of patients at risk for developing COPD, based on recognized risk factors and symptoms, and use of spirometry is required to enable early diagnosis and to initiate prompt maintenance treatment. The management of COPD includes pharmacologic therapy, but also many non-pharmacologic strategies (invasive and non-invasive mechanical ventilation, pulmonary rehabilitation).
All of these strategies, in various combinations depending on the severity of these conditions, will contribute to a better outcome for our asthma and COPD patients.