Treatment Pathway
Treatment of Obstructive Sleep Apnea
OSA is a common sleep disorder where the throat muscles intermittently relax and block the airway during sleep. Untreated, it significantly increases cardiovascular disease risk.
GINA (Global Initiative for Asthma)GOLD (COPD)BTS/SIGN UK GuidelinesATS/ERS (American/European Thoracic Society)WHO
OSA is a common sleep disorder where the throat muscles intermittently relax and block the airway during sleep. Untreated, it significantly increases cardiovascular disease risk.
First-Line Treatment Principles
- ✓Identify and address triggers (allergens, occupational exposures, smoking)
- ✓Inhaled corticosteroid (ICS) is cornerstone of persistent asthma management
- ✓Short-acting bronchodilator (SABA/SAMA) for rescue symptom relief
- ✓Stepwise therapy escalation: ICS → ICS/LABA → add-on biologics if severe
- ✓Pulmonary rehabilitation for COPD (GOLD stage B/C/D)
Non-Pharmacological Management
- •Smoking cessation — single most effective intervention in COPD (slows FEV1 decline)
- •Trigger avoidance: dust mites, pet dander, pollen, mould, cold air, NSAIDs
- •Annual influenza vaccination; pneumococcal vaccination in high-risk patients
- •Pulmonary rehabilitation: supervised exercise + education programme
- •Breathing techniques (pursed-lip breathing, diaphragmatic breathing) for COPD
- •Optimise nutritional status; treat obesity as it worsens respiratory mechanics
- •Supplemental oxygen if SpO2 <88% at rest or <92% with significant desaturation on exertion
Treatment Goals
🎯Symptom control: minimal daytime symptoms, no nocturnal waking
🎯Preserved lung function (FEV1 decline minimised in COPD)
🎯Prevention of exacerbations: ≤1 per year
🎯Normal or near-normal physical activity
🎯Avoidance of side effects (steroid complications with high-dose ICS)
Monitoring Parameters
- ◆Spirometry (FEV1, FVC, FEV1/FVC): baseline and annually in COPD; assessment after treatment changes
- ◆Peak expiratory flow (PEF): self-monitoring in asthma (symptom-based or twice daily)
- ◆Oxygen saturation (SpO2): with exacerbations or progressive disease
- ◆Symptom scores: ACQ/ACT (asthma), CAT/mMRC (COPD) at each visit
- ◆Exacerbation frequency: a key driver of treatment escalation in both asthma and COPD
- ◆Inhaler technique review at every clinical encounter
Escalation Criteria
- →Severe acute asthma: PEFR <50% best → hospitalisation, IV corticosteroids, nebulised bronchodilators
- →COPD acute exacerbation: worsening dyspnoea + purulent sputum → antibiotics + systemic corticosteroids
- →Inadequate control on ICS/LABA → consider add-on LAMA, biologics (severe eosinophilic asthma), or specialist referral
- →New respiratory failure (PaO2 <8 kPa, rising CO2) → urgent hospital assessment
Special Populations
Children: weight-appropriate dosing; spacer devices for pMDI; reassess diagnosis at each stage
Pregnancy: ICS and SABA safe; LABA use acceptable if benefit outweighs risk; smoking cessation critical
Elderly: increased risk of ICS-related osteoporosis; co-existing cardiovascular disease may limit beta-agonist use
Athletes: check WADA permitted status for inhaled medications
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