Interventions for Chronic Obstructive Pulmonary Disease

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Age Cohort: 25 - 59 years

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Create awareness on risk factors and preventive measures of COPD * Multi sectoral approach to ensure clean environments	Avoidance of tobacco smoking (including second-hand smoke), Avoidance of occupational exposure to dusts, fumes or chemicals Avoiding air pollution and allergens Avoidance of solid fuel based indoor air pollution	Recognition of obstructive lung disease signs and symptoms	Smoking cessation Short-acting beta2-agonists (SABAs) Immediate transfer of severe cases to a higher-level health care facility	Home-based self-management rehabilitation Breathing exercise	Non-pharmacological treatment to relieve the discomfort of shortness of breath or anxiety Emotional, social, spiritual assessment and support based on cultural needs, values and preferences of patients and families
Primary Care
Regular patients’ education on smoking cessation and treatment adherence	Guidance and counselling on risk of smoking and second hand smoke Counselling support to quit smoking Vaccination: pneumonia and COVID Annual influenza vaccination	History Physical examination A 6-minute walk test Complete blood count Chest radiography	Smoking cessation Short-acting beta2-agonists (SABAs) Long-acting beta2-agonists (LABA) Inhaled corticosteroids (ICS Immediate transfer of severe cases to a higher-level health care facility	Pulmonary Rehabilitation: exercise, dietary advice, disease education, psychological intervention, behavioural intervention	Pharmacological and non-pharmacological treatment to relieve the discomfort of shortness of breath or anxiety Emotional, social, spiritual assessment and support based on cultural needs, values and preferences of patients and families
Referral Facility: General
Regular patients’ education on smoking cessation and treatment adherence	Guidance and counselling on risk of smoking and second hand smoke Counselling support to quit smoking Vaccination: pneumonia, influenza and COVID Annual influenza vaccination	History Physical examination Spirometry test A 6-minute walk test modified British Medical Research Council (mMRC) questionnaire COPD Assessment Test (CAT) Complete blood count Alpha-1 antitrypsin test Chest radiography	Smoking cessation Short-acting beta2-agonists (SABAs) Long-acting beta2-agonists (LABA) Short-acting antimuscarinic agents (SAMA) Long-acting antimuscarinic agents (LAMA) Inhaled corticosteroids (ICS) Systemic glucocorticoids Antibiotics	Pulmonary Rehabilitation: exercise, dietary advice, disease education, psychological intervention, behavioural intervention	Pharmacological and non-pharmacological treatment to relieve the discomfort of shortness of breath or anxiety Emotional, social, spiritual assessment and support based on cultural needs, values and preferences of patients and families
Referral Facility: Specialist
Raise awareness among the communities on COPD Advocacy for creation of more healthy environments, especially for poor and disadvantaged populations; Advocacy on reducing the risk factors such as tobacco smoking and exposure to second-hand smoke, Distribution of IEC materials Health workers training on COPD	Guidance and counselling on smoking cessation and treatment adherence	History Physical examination Spirometry test A 6-minute walk test modified British Medical Research Council (mMRC) questionnaire COPD Assessment Test (CAT) Complete blood count Alpha-1 antitrypsin level Chest radiography Computed tomography (CT) Biopsy	Smoking cessation Short-acting beta2-agonists (SABAs) Long-acting beta2-agonists (LABA) Short-acting antimuscarinic agents (SAMA) Long-acting antimuscarinic agents (LAMA) Inhaled corticosteroids (ICS) Systemic glucocorticoids Phosphodiesterase-4 (PDE4) inhibitors Antibiotics	Pulmonary Rehabilitation: exercise, dietary advice, disease education, psychological intervention, behavioural intervention	Pharmacological and non-pharmacological treatment to relieve the discomfort of shortness of breath, anxiety, fear and depression

Age Cohort: 60+ years

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Create awareness on risk factors and preventive measures of COPD * Multi sectoral approach to ensure clean environments	Avoidance of tobacco smoking (including second-hand smoke), Avoidance of occupational exposure to dusts, fumes or chemicals Avoiding air pollution and allergens Avoidance of solid fuel based indoor air pollution Replacement of indoor stoves with smokeless technology	Recognition of obstructive lung disease signs and symptoms	Smoking cessation Short-acting beta2-agonists (SABAs) Immediate transfer of severe cases to a higher-level health care facility Nicotine replacement	Smoking cessation Short-acting beta2-agonists (SABAs) Immediate transfer of severe cases to a higher-level health care facility Addition of person-centered care services to usual care in chronic heart failure or COPD for individualised health plan	Non-pharmacological treatment to relieve the discomfort of shortness of breath or anxiety Emotional, social, spiritual assessment and support based on cultural needs, values and preferences of patients and families
Primary Care
Regular patients’ education on smoking cessation and treatment adherence Removal of exposure to smoking and second hand smoke	Guidance and counselling on risk of smoking and second hand smoke Counselling support to quit smoking Vaccination: pneumonia, and COVID Annual influenza vaccination	History Physical examination A 6-minute walk test Complete blood count Chest radiography	Smoking cessation Short-acting beta2-agonists (SABAs) Long-acting beta2-agonists (LABA) Inhaled corticosteroids (ICS Immediate transfer of severe cases to a higher-level health care facility	Pulmonary Rehabilitation	Pharmacological and non-pharmacological treatment to relieve the discomfort of shortness of breath or anxiety Emotional, social, spiritual assessment and support based on cultural needs, values and preferences of patients and families
Referral Facility: General
Regular patients’ education on smoking cessation and treatment adherence Removal of exposure to smoking and second hand smoke	Guidance and counselling on risk of smoking and second hand smoke Counselling support to quit smoking Vaccination: pneumonia, influenza and COVID Annual influenza vaccination	History Physical examination Spirometry test A 6-minute walk test modified British Medical Research Council (mMRC) questionnaire COPD Assessment Test (CAT) Complete blood count Alpha-1 antitrypsin test Chest radiography	Smoking cessation Short-acting beta2-agonists (SABAs) Long-acting beta2-agonists (LABA) Short-acting antimuscarinic agents (SAMA) Long-acting antimuscarinic agents (LAMA) Inhaled corticosteroids (ICS) Systemic glucocorticoids Antibiotics Nicotine replacement	Pulmonary Rehabilitation Addition of person-centered care services to usual care in chronic heart failure or COPD for individualised health plan	Pharmacological and non-pharmacological treatment to relieve the discomfort of shortness of breath or anxiety Emotional, social, spiritual assessment and support based on cultural needs, values and preferences of patients and families
Referral Facility: Specialist
Raise awareness among the communities on COPD Advocacy for creation of more healthy environments, especially for poor and disadvantaged populations Advocacy on reducing the risk factors such as tobacco smoking and exposure to second-hand smoke, Distribution of IEC materials Health workers training on COPD Removal of exposure to smoking and second hand smoke	Guidance and counselling on smoking cessation and treatment adherence	History Physical examination Spirometry test A 6-minute walk test modified British Medical Research Council (mMRC) questionnaire COPD Assessment Test (CAT) Complete blood count Alpha-1 antitrypsin level Chest radiography Computed tomography (CT) Biopsy	Smoking cessation Short-acting beta2-agonists (SABAs) Long-acting beta2-agonists (LABA) Short-acting antimuscarinic agents (SAMA) Long-acting antimuscarinic agents (LAMA) Inhaled corticosteroids (ICS) Systemic glucocorticoids Phosphodiesterase-4 (PDE4) inhibitors Antibiotics Improved access to Inhaled corticosteroids and long acting β agonists for asthma and COPD	Pulmonary rehabilitation Addition of person-centered care services to usual care in chronic heart failure or COPD for individualised health plan	Pharmacological and non-pharmacological treatment to relieve the discomfort of shortness of breath, anxiety, fear and depression