Evidence-based management of Chronic Obstructive Pulmonary Disease according to Uganda Clinical Guidelines 2023
Uganda Clinical Guidelines 2023 · all from source →
General Adult
Diagnosis
Clinical Features
Chronic cough in smoker >40 years. Progressive breathlessness. Chronic sputum production for at least 3 months in 2 successive years. Barrel chest, rapid breathing.
Investigations
Spirometry (gold standard). Chest X-ray (hyper-inflated lungs).
Treatment
Non-pharmacological
Stop smoking. Reduce exposure to indoor biomass smoke. Physical exercise (pulmonary rehabilitation).
Step 1: Mild
Inhaled salbutamol 2 puffs 2-4 times a day (to reduce symptoms). If inhalers not available: Aminophylline 200 mg twice daily.
Step 2: Moderate
Inhaled salbutamol 2 puffs 2-4 times a day PLUS inhaled steroid beclomethasone 100-400 mcg 2-4 times a day.
Step 3: Severe
Step 2 regimen PLUS ipratropium inhaler 2 puffs 2-4 times a day. Long-acting bronchodilators (salmeterol/formoterol) can be used.
COPD Exacerbations
If increased purulent sputum/fever/breathlessness: Treat with antibiotic (Amoxicillin 500 mg 8 hourly OR Doxycycline 100 mg 12 hourly for 7-10 days). Oral Prednisolone 40 mg once daily for 5 days. Oxygen by nasal cannula (1-3 L/min, target SpO2 88-92%).
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