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The outpatient diagnosis and management of chronic obstructive pulmonary disease

Pharmacotherapy, administration of supplemental oxygen, and smoking cessation techniques

  • Clinical Review
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Conclusions

Chronic obstructive pulmonary disease is a common medical problem seen in the outpatient setting. The diagnosis of airways limitation and its severity are based on spirometry. Other information from the pulmonary function laboratory, such as the bronchodilator response and changes in spirometry during serial testing, must be interpreted cautiously. The pharmacotherapy for COPD has evolved with the use of inhaled medications, particularly inhaled parasympatholytics, with less of an emphasis on theophylline. The role of inhaled corticosteroids in COPD is unclear, although used together with bronchodilators, inhaled corticosteroids may have beneficial long-term effects on airways limitation, compared with the use of bronchodilators alone. All patients with hypoxemic COPD should be formally assessed for the need for supplemental oxygen. Surgical options for patients with severe COPD are increasing. The primary care physician has a pivotal role to play in smoking cessation and familiarity with the new nicotine replacement products, and behavior modification programs are essential. General internists caring for patients with COPD should consider a consultation with a pulmonary specialist for a patient with persistent dyspnea despite adequate pharmacotherapy or for a patient who develops evidence of lung cancer, such as hemoptysis or abnormalities in a chest roentgenograph.

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Authors and Affiliations

  1. the Section of Pulmonary and Critical Care Medicine, the Clement J. Zablocki Veterans Affairs Medical Center, USA

    Ralph M. Schapira MD & Lynn F. Reinke RN, MSN

  2. the Nursing Service, the Clement J. Zablocki Veterans Affairs Medical Center, USA

    Lynn F. Reinke RN, MSN

  3. the Division of Pulmonary and Critical Care Medicine, Department of Medicine, the Medical College of Wisconsin, Milwaukee, Wisconsin

    Ralph M. Schapira MD

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  1. Ralph M. Schapira MD
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  2. Lynn F. Reinke RN, MSN
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Schapira, R.M., Reinke, L.F. The outpatient diagnosis and management of chronic obstructive pulmonary disease. J Gen Intern Med 10, 40–55 (1995). https://doi.org/10.1007/BF02599577

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