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Management of chronic obstructive pulmonary disease

Comprehensive Therapy volume 32, pages 230–235 (2006)Cite this article

Original Article

Chronic obstructive pulmonary disease (COPD) is a major cause of mortality and morbidity throughout the world. It is the only cause of death among the top 10 causes that is increasing and is expected to become the third leading cause of death in the world by 2020. A diagnosis of COPD should be considered in any patient with previous exposure to risk factors for the disease and/or the presence of chronic cough, sputum production, or dyspnea. Patients with COPD are categorized into five stages based on their pulmonary function tests and symptoms. Smoking cessation is the single most effective way to halt the progression of COPD and prolong life. Pharmacological management of stable COPD includes the use of bronchodilators (Β2 agonists, anticholinergics and methylxanthines) and inhaled corticosteroids. Other adjunctive measures include vaccination, oxygen therapy, pulmonary rehabilitation, and certain surgical measures like bullectomy and lung transplantation. Management of acute exacerbations includes the use of systemic steroids, antibiotics, bronchodilators, and oxygen therapy. During very severe exacerbations, patients may need ventilatory support.

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References

  1. Executive Summary: Global Strategy for the Diagnosis, Management, and Prevention of COPD (updated Sep 2005). www.goldcopd.org.

  2. Xu X, Weiss ST, Rijcken B, et al. Smoking, changes in smoking habits, and rate of decline in FEV1: new insight into gender differences. Eur Respir J 1994;7(6): 1056–1061.

    CAS  PubMed  Google Scholar 

  3. Anthonisen NR, Connett JE, Murray RP. Smoking and lung function of Lung Health Study participants after 11 years. Am J Respir Crit Care Med 2002;166(5):675–679.

    Article  PubMed  Google Scholar 

  4. Guyatt GH, Townsend M, Pugsley SO, et al. Bronchodilators in chronic air-flow limitation. Effects on airway function, exercise capacity, and quality of life. Am Rev Respir Dis 1987;135(5):1069–1074.

    CAS  PubMed  Google Scholar 

  5. Man WD, Mustfa N, Nikoletou D, et al. Effect of salmeterol on respiratory muscle activity during exercise in poorly reversible COPD. Thorax 2004;59(6):455–457.

    Article  Google Scholar 

  6. Nelson HS, Weiss ST, Bleecker ER, et al. The Salmeterol Multicenter Asthma Research Trial: a comparison of usual pharmacotherapy for asthma or usual pharmacotherapy plus salmeterol. Chest 2006;129(1):15–26.

    CAS  Article  PubMed  Google Scholar 

  7. Sin DD, McAlister FA, Man SF, et al. Contemporary management of chronic obstructive pulmonary disease: scientific review. JAMA 2003;290(17):2301–2312.

    CAS  Article  PubMed  Google Scholar 

  8. Highland KB, Strange C, Heffner JE. Long-term effects of inhaled corticosteroids on FEV1 in patients with chronic obstructive pulmonary disease. A meta-analysis. Ann Intern Med 2003;139(10):873.

    Google Scholar 

  9. Sutherland ER, Allmers H, Ayas NT, et al. Inhaled corticosteroids reduce the progression of airflow limitation in chronic obstructive pulmonary disease: a meta-analysis. Thorax 2003;58(11):937–941.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  10. Alsaeedi, Sin DD, McAlister FA. The effects of inhaled corticosteroids in chronic obstructive pulmonary disease: a systematic review of randomized placebo-controlled trials. Am J Med 2002;113(1):59–65.

    CAS  Article  PubMed  Google Scholar 

  11. Burge PS, Calverley PM, Jones PW, et al. Randomised, double blind, placebo controlled study of fluticasone propionate in patients with moderate to severe chronic obstructive pulmonary disease: the ISOLDE trial. BMJ 2000;320(7245):1297–1303.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  12. Calverley P, Pauwels R, Vestbo J, et al. Combined salmeterol and fluticasone in the treatment of chronic obstructive pulmonary disease: a randomized controlled trial. Lancet 2003361(9356):449–456.

    CAS  Article  PubMed  Google Scholar 

  13. Mahler DA, Wire P, Horstman D, et al. Effectiveness of fluticasone propionate and salmeterol combination delivered via the Diskus device in the treatment of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2002;166(8):1084–1091.

    Article  PubMed  Google Scholar 

  14. Szafranski W, Cukier A, Ramirez A, et al. Efficacy and safety of budesonide/formoterol in the management of chronic obstructive pulmonary disease. Eur Respir J 2003;21(1):74–81.

    CAS  Article  PubMed  Google Scholar 

  15. Hanania NA, Darken P, Horstman D, et al. The efficacy and safety of fluticasone propionate (250 microg)/salmeterol (50 microg) combined in the Diskus inhaler for the treatment of COPD. Chest 2003;124(3):834–843.

    CAS  Article  PubMed  Google Scholar 

  16. Calverley PM, Boonsawat W, Cseke Z, et al. Maintenance therapy with budesonide and formoterol in chronic obstructive pulmonary disease. Eur Respir J 2003;22(6):912–919.

    CAS  Article  PubMed  Google Scholar 

  17. Burge PS, Calverley PM, Jones PW, et al. Prednisolone response in patients with chronic obstructive pulmonary disease: results from the ISOLDE study. Thorax 2003;58(8):654–658.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  18. Rice KL, Rubins JB, Lebahn F, et al. Withdrawal of chronic systemic corticosteroids in patients with COPD: a randomized trial. Am J Respir Crit Care Med 2000;162(1):174–178.

    CAS  Article  PubMed  Google Scholar 

  19. Decramer M, Lacquet LM, Fagard R, et al. Corticosteroids contribute to muscle weakness in chronic airflow obstruction. Am J Respir Crit Care Med 1994; 150(1): 11–16.

    CAS  Article  PubMed  Google Scholar 

  20. Decramer M, Stas KJ. Corticosteroid-induced myopathy involving respiratory muscles in patients with chronic obstructive pulmonary disease or asthma. Am Rev Respir Dis 1992;146(3):800–802.

    CAS  Article  PubMed  Google Scholar 

  21. Wongsurakiat P, Lertakyamanee J, Maranetra KN, et al. Economic evaluation of influenza vaccination in Thai chronic obstructive pulmonary disease patients. J Med Assoc Thai 2003;86(6):497–508.

    PubMed  Google Scholar 

  22. Simberkoff MS, Cross AP, Al-Ibrahim M, et al. Efficacy of pneumococcal vaccine in high-risk patients. Results of a Veterans Administration Cooperative Study. N Engl J Med 1986;315(21):1318–1327.

    CAS  Article  PubMed  Google Scholar 

  23. Williams JH Jr, Moser KM. Pneumococcal vaccine and patients with chronic lung disease. Ann Intern Med 1986;104(1):106–109.

    Article  PubMed  Google Scholar 

  24. Continuous or nocturnal oxygen therapy in hypoxemic chronic obstructive lung disease: a clinical trial. Nocturnal Oxygen Therapy Trial Group. Ann Intern Med 1980;93(3):391–398.

    Article  Google Scholar 

  25. Gorecka D, Gorzelak K, Sliwinski P, et al. Effect of long-term oxygen therapy on survival in patients with chronic obstructive pulmonary disease with moderate hypoxaemia. Thorax 1997;52(8): 674–679.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  26. Takabatake N, Nakamura H, Abe S, et al. The relationship between chronic hypoxemia and activation of the tumor necrosis factor-alpha system in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2000;161(4 Pt 1):1179–1184.

    CAS  Article  PubMed  Google Scholar 

  27. Heindl S, Lehnert M, Criee CP, et al. Marked sympathetic activation in patients with chronic respiratory failure. Am J Respir Crit Care Med 2001 15;164(4):597–601.

    CAS  Article  PubMed  Google Scholar 

  28. Bratel T, Wennlund A, Carlstrom K. Impact of hypoxaemia on neuroendocrine function and catecholamine secretion in chronic obstructive pulmonary disease (COPD). Effects of long-term oxygen treatment. Respir Med 2000;94(12):1221–1228.

    CAS  Article  PubMed  Google Scholar 

  29. Guyatt GH, McKim DA, Austin P, et al. Appropriateness of domiciliary oxygen delivery. Chest 2000;118(5):1303–1308.

    CAS  Article  PubMed  Google Scholar 

  30. Griffiths TL, Burr ML, Campbell IA, et al. Results at 1 year of outpatient multidisciplinary pulmonary rehabilitation: a randomised controlled trial. Lancet 2000;355(9211):1280.

    Article  Google Scholar 

  31. Mehran RJ, Deslauriers J. Indications for surgery and patient workup for bullectomy. Chest Surg Clin N Am 1995;5(4):717–734.

    CAS  PubMed  Google Scholar 

  32. Maurer JR, Frost AE, Estenne M, et al. International guidelines for the selection of lung transplant candidates. The International Society for Heart and Lung Transplantation, the American Thoracic Society, the American Society of Transplant Physicians, the European Respiratory Society. Transplantation 1998;66(7):951–956.

    CAS  Article  PubMed  Google Scholar 

  33. Moayyedi P, Congleton J, Page RL, et al. Comparison of nebulised salbutamol and ipratropium bromide with salbutamol alone in the treatment of chronic obstructive pulmonary disease. Thorax 1995;50(8):834–837.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  34. Thompson WH, Nielson CP, Carvalho P, et al. Controlled trial of oral prednisone in outpatients with acute COPD exacerbation. Am J Respir Crit Care Med 1996;154(2 Pt 1):407–412.

    CAS  Article  PubMed  Google Scholar 

  35. Davies L, Angus RM, Calverley PM. Oral corticosteroids in patients admitted to hospital with exacerbations of chronic obstructive pulmonary disease: a prospective randomised controlled trial. Lancet 1999;354(9177):440–441.

    Article  Google Scholar 

  36. Niewoehner DE, Erbland ML, Deupree RH, et al. Effect of systemic glucocorticoids on exacerbations of chronic obstructive pulmonary disease. Department of Veterans Affairs Cooperative Study Group. N Engl J Med 1999;340(25):1941–1947.

    CAS  Article  PubMed  Google Scholar 

  37. Maltais F, Ostinelli J, Bourbeau J, et al. Comparison of nebulized budesonide and oral prednisolone with placebo in the treatment of acute exacerbations of chronic obstructive pulmonary disease: a randomized controlled trial. Am J Respir Crit Care Med 2002;165(5):698–703.

    Article  PubMed  Google Scholar 

  38. Sethi S, Evans N, Grant BJ, New strains of bacteria and exacerbations of chronic obstructive pulmonary disease. N Engl J Med 2002;347(7):465–471.

    Article  PubMed  Google Scholar 

  39. Anthonisen NR, Manfreda J, Warren CP, et al. Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease. Ann Intern Med 1987;106(2):196–204.

    CAS  Article  PubMed  Google Scholar 

  40. Jorgensen AF, Coolidge J, Pedersen PA, et al. Amoxicillin in treatment of acute uncomplicated exacerbations of chronic bronchitis. A double-blind, placebo-controlled multicentre study in general practice. Scand J Prim Health Care 1992;10(1):7–11.

    CAS  Article  PubMed  Google Scholar 

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Author information

Affiliations

  1. Division of Pulmonary/Critical Care Medicine, Department of Medicine, New York Medical College, Valhalla, NY

    Dipak Chandy MD

  2. Divisions of Cardiology, Geriatrics and Pulmonary/Critical Care Medicine, Department of Medicine, New York Medical College, Valhalla, NY

    Wilbert S. Aronow

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  1. Dipak Chandy MD
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  2. Wilbert S. Aronow
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Correspondence to Dipak Chandy MD.

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Cite this article

Chandy, D., Aronow, W.S. Management of chronic obstructive pulmonary disease. Compr Ther 32, 230–235 (2006). https://doi.org/10.1007/BF02698068

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  • DOI: https://doi.org/10.1007/BF02698068

Keywords

  • Chronic Obstructive Pulmonary Disease
  • Salmeterol
  • Varenicline
  • Respir Crit
  • Formoterol