Feature Article

Managing severe COPD: much can be done

Karen M Detering, Tracy Smith, Christine McDonald



Severe COPD may be challenging to manage as patients often experience debilitating symptoms that fail to respond completely to disease-specific treatment. Clear communication about the goals of care combined with management of symptoms and comorbidities should enable patients to enjoy a better quality of life.

Key Points

  • Management of patients with severe COPD is challenging, but with a combination of therapeutic approaches much can be achieved.
  • Pulmonary rehabilitation may improve symptoms and quality of life and reduce exacerbations in patients at all stages of disease severity.
  • Detecting and managing comorbidities, including cardiac disease, osteoporosis, anxiety and depression, are important in improving patient outcomes.
  • Oxygen therapy improves prognosis in patients with chronic hypoxaemia.
  • Noninvasive ventilation is useful in managing acute hypercapnic exacerbations of COPD.
  • Clear communication focusing on likely disease trajectory, prognosis, goals of care and advance care planning is essential.
  • Patients with very severe COPD may require palliative care, ideally provided by their usual care providers, but some patients require specialist palliative care referral.