All patients with COPD are advised to be vaccinated with the pneumococcal vaccine and have an annual (inactivated) influenza vaccine.[15]

Any patient with COPD who is still smoking should be encouraged to stop with an appropriate intervention such as nicotine replacement therapy, varenicline or bupropion with a support programme.[4]

Pathophysiology in COPD is predominantly neutrophilic inflammation which responds poorly to inhaled corticosteroids (ICS), unlike asthma which is mainly eosinophilic inflammation. This makes it important to distinguish between COPD and asthma, as inappropriate ICS use increases risk of pneumonia and osteoporosis monotherapy. Also, long-acting bronchodilators should be avoided in asthma as this can exacerbate asthma flareups.[16,17]

Among drug treatments for COPD, bronchodilators are the most important, while steroids have a much more limited role, especially if there is limited reversal of airway blockages. Approaches depend on whether the COPD is stable or there is a flare up, and whether or not there are asthmatic features or features suggesting steroid responsiveness.[5,15]