Lifestyle advice for COPD (chronic obstructive pulmonary disease)-OSAHS (obstructive sleep apnoea/hypopnoea syndrome) overlap syndrome
explain to people with mild COPD-OSAHS who have no symptoms or with symptoms that do not affect usual daytime activities that:
- treatment is not usually needed and
- changes to lifestyle and sleep habits can help to prevent COPD-OSAHS from worsening
- lifestyle advice for all severities of COPD-OSAHS
- discuss appropriate lifestyle changes with all people with COPD-OSAHS. Provide support and information on losing weight, stopping smoking, reducing alcohol intake and improving sleep hygiene, tailored to the person's needs and in line with the NICE guidelines on:
- stop smoking interventions and services
- preventing excess weight gain
- obesity: identification, assessment and management (in particular, the section on lifestyle interventions)
- alcohol-use disorders: prevention (in particular, recommendations on screening, brief advice and extended brief interventions for adults)
Treatments for COPD (chronic obstructive pulmonary disease)-OSAHS (obstructive sleep apnoea/hypopnoea syndrome) overlap syndrome
CPAP and non-invasive ventilation
- consider continuous positive airway pressure (CPAP) as first-line treatment for people with COPD-OSAHS overlap syndrome if they do not have severe hypercapnia (PaCO2 of 7.0 kPa or less)
- consider non-invasive ventilation instead of CPAP for people with COPD–OSAHS overlap syndrome with nocturnal hypoventilation if they have severe hypercapnia (PaCO2 greater than 7.0 kPa)
- consider heated humidification in addition to CPAP for people with COPD–OSAHS overlap syndrome and upper airway side effects such as nasal and mouth dryness, and CPAP-induced rhinitis
Oxygen therapy
- consider supplemental oxygen for people with COPD-OSAHS overlap syndrome if hypoxaemia persists once control of apnoea and nocturnal hypoventilation has been optimised by CPAP or non-invasive ventilation, and address any additional underlying causes of hypoxaemia where possible
Managing rhinitis in people with COPD (chronic obstructive pulmonary disease)-OSAHS (obstructive sleep apnoea/hypopnoea syndrome) overlap syndrome
- assess people with nasal congestion and COPD-OSAHS for underlying allergic or vasomotor rhinitis
- if rhinitis is diagnosed in people with COPD-OSAHS, offer initial treatment with:
- topical nasal corticosteroids or antihistamines for allergic rhinitis or
- topical nasal corticosteroids for vasomotor rhinitis
- for people with COPD-OSAHS and persistent rhinitis, consider referral to an ear, nose and throat specialist if:
- symptoms do not improve with initial treatment or
- anatomical obstruction is suspected
- be aware that:
- rhinitis can affect people's tolerance to continuous positive airway pressure (CPAP) but changing from a nasal to an orofacial mask and adding humidification can help
- CPAP can worsen or cause rhinitis and nasal congestion
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