Skip to main content
SpringerLink
Log in

Management of Chronic Obstructive Pulmonary Disease

  • Practical Therapeutics
  • Published:
Drugs Aims and scope Submit manuscript

Summary

Chronic obstructive pulmonary disease (COPD) is characterised by insidiously progressive airflow limitation. The necessarily multifactorial management programme should include smoking cessation, prevention of infections, bronchodilator and steroid therapy, supplemental oxygen, physical therapy, pulmonary rehabilitation programmes, psychosocial support and treatment of concomitant disease. There have been many advances in medical therapy but some of the notorious controversies remain. New sympathomimetic agents and methylxanthines, as well as the availability of inhaled anticholinergic medications free of toxicity, have led to improvement in symptoms and complications related to COPD. There is a clear place for the judicious use of systemic steroids.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Albert RK, Martin TR, Lewis SW. Controlled clinical trial of methylprednisolone in patients with chronic bronchitis and acute respiratory insufficiency. Annals of Internal Medicine 92: 753–758, 1980

    PubMed  CAS  Google Scholar 

  • American College of Physicians Health and Public Policy Committee. Methods for stopping cigarette smoking. Annals of Internal Medicine 105: 281–291, 1986a

    Google Scholar 

  • American College of Physicians Health and Public Policy Committee. Pneumococcal vaccine. Annals of Internal Medicine 104: 118–120, 1986b

    Google Scholar 

  • American Thoracic Society. Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease (COPD) and asthma. American Review of Respiratory Disease 136: 225–244, 1987

    Article  Google Scholar 

  • Anthonisen NR. Corticosteroids in chronic obstructive lung disease. Clinical Challenges in Cardiopulmonary Medicine 4(2): 1–5, 1982

    Google Scholar 

  • Anthonisen NR, Manfreda J, Warren CPW, Hershfíeld ES, Harding GKM, et al. Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease. Annals of Internal Medicine 106: 196–204, 1987

    PubMed  CAS  Google Scholar 

  • Aubier M. Effect of theophylline on diaphragmatic muscle function. Chest 92: 27S–31S, 1987

    PubMed  CAS  Google Scholar 

  • Austrian R, Douglas RM, Schiffman G, Coetzee AM, Koornhof HS, et al. Prevention of pneumococcal pneumonia by vaccination. Transactions of the Association of American Physicians 89: 184–194, 1976

    PubMed  CAS  Google Scholar 

  • Bell FC, Mullins RC, West LG, Bachand RT, Johanson WG. The effect of almitrine bismesylate on hypoxemia in chronic obstructive pulmonary disease. Annals of Internal Medicine 105: 342–346, 1986

    PubMed  CAS  Google Scholar 

  • Belman MJ. Exercise in chronic obstructive pulmonary disease. Clinics in Chest Medicine 7: 585–597, 1986

    PubMed  CAS  Google Scholar 

  • Bergstrand J. Phosphodiesterase inhibition and theophylline. European Journal of Respiratory Diseases 109 (Suppl.): 37, 1980

    CAS  Google Scholar 

  • Blum A. Nicotine chewing gum and the medicalization of smoking. Annals of Internal Medicine 101: 121–123, 1984

    PubMed  CAS  Google Scholar 

  • Brain J. Aerosol and humidity therapy. American Review of Respiratory Disease 122 (Suppl.): 17–21, 1980

  • Bukowsyj M, Nakatsu K, Munt PW. Theophylline reassessed. Annals of Internal Medicine 101: 63–73, 1984

    Google Scholar 

  • Burrows B, Earle RH. Course and prognosis of chronic obstructive lung disease. New England Journal of Medicine 280: 397–404, 1969

    Article  PubMed  CAS  Google Scholar 

  • Centers for Disease Control, Department of Health and Human Services. Update: pneumococcal polysaccharide vaccine usage — United States. Recommendations of the Immunization Practices Advisory Committee. Annals of Internal Medicine 101: 348–350, 1984

    Google Scholar 

  • Chapman KR, Smith DL, Rebuck AS, Leenen FHH. Hemody- namic effects of an inhaled beta-2 agonist. Clinical Pharmacology and Therapeutics 35: 762–767, 1984

    Article  PubMed  CAS  Google Scholar 

  • Chapman KR, Smith DL, Rebuck AS, Leenen FHH. Hemodynamic effects of inhaled ipratropium bromide alone and combined with an inhaled beta-2 agonist. American Review of Respiratory Disease 132: 845–847, 1985

    PubMed  CAS  Google Scholar 

  • Christopher KL, Spifford BT, Petrum MD, McCarty DC, Goodman JR, et al. A program for transtracheal oxygen delivery: assessment of safety and efficacy. Annals of Internal Medicine 107: 802–808, 1987

    PubMed  CAS  Google Scholar 

  • Clark SW. The effect of theophylline on mucociliary transport. In Jonkman JGH et al. (Eds) Sustained release theophylline in the treatment of CRAO, p. 22, Excerpta Medica, Amsterdam, 1984

    Google Scholar 

  • Dolovich M, Fuffín RE, Roberts R, Newhouse MT. Optimal delivery of aerosols from metered dose inhalers. Chest 80 (Suppl.): 911–918, 1981

    PubMed  CAS  Google Scholar 

  • Dulfano MJ, Glass P. The bronchodilator effects of terbutaline: route of administration and patterns of response. Annals of Allergy 37: 357, 1976

    PubMed  CAS  Google Scholar 

  • Easton PA, Carlos J, Dhingra S, Anthonisen NR. A comparison of the bronchodilating effects of a beta-2 adrenergic agent (al-buterol) and an anticholinergic agent (ipratropium bromide), given by aerosol alone or in sequence. New England Journal of Medicine 315: 735–739, 1986

    Article  PubMed  CAS  Google Scholar 

  • Eaton ML, Green BA, Church TR, McGowan T, Niewoehner DE. Efficacy of theophylline in ‘irreversible’ airflow obstruction. Annals of Internal Medicine 92: 758–761, 1980

    PubMed  CAS  Google Scholar 

  • Editorial. Deaths due to chronic obstructive pulmonary disease and allied conditions. Morbidity and Mortality Weekly Report 35: 507–510, 1985

  • Editorial. Influenza prevention, 1987–1988. Medical Letter 29: 81–82, 1987

  • Eliasson O, Hoffman J, Trueb D, Frederick D, McCormick JR. Corticosteroids in COPD: a clinical trial and reassessment of the literature. Chest 89: 484–490, 1986

    Article  PubMed  CAS  Google Scholar 

  • Farer LS, Schieffeibein CW. Position paper on respiratory diseases. In Amler RW & Dull HB (Eds) Closing the gap, pp. 115–124, The Carter Center of Emory University, Health Policy Project, Atlanta, Georgia, 1984

    Google Scholar 

  • Foster WM, Bergofsky EH, Bohning DE, Lippmann M, Albert RE. Effect of adrenergic agents and their mode of action on mucociliary clearance in man. Journal of Applied Physiology 41: 146–152, 1979

    Google Scholar 

  • Gross NJ, Skorodin MS. Anticholinergic, antimuscarinic bronchodilators. American Review of Respiratory Disease 129: 856–870, 1984

    PubMed  CAS  Google Scholar 

  • Guyatt GH, Townsend M, Kazim F, Newhouse MT. A controlled trial of ambroxol in chronic bronchitis. Chest 92: 618–620, 1987

    Article  PubMed  CAS  Google Scholar 

  • Hertzel MR, Clark TJN. Comparison of intravenous and aerosol salbutamol. British Medical Journal 2: 919, 1976

    Article  Google Scholar 

  • Hughes JA, Tobin MJ, Bellamy D, Hutchison DCS. Effects of ipratropium bromide and fenoterol aerosols in pulmonary emphysema. Thorax 37: 667–670, 1982

    Article  PubMed  CAS  Google Scholar 

  • Ingram CG, Sinclair DJM. Controlled trial of supervised exercise training in chronic bronchitis. British Medical Journal 280: 519–521, 1980

    Article  PubMed  Google Scholar 

  • Jenkins SC, Heaton RW, Fulton TJ, Moxham J. Comparison of domiciliary nebulized salbutamol and salbutamol from a metered-dose inhaler in stable chronic airflow limitation. Chest 91: 804–807, 1987

    Article  PubMed  CAS  Google Scholar 

  • Jenne JW. Theophylline as a bronchodilator in COPD and its combination with inhaled β-adrenergic drugs. Chest 92: 7S–14S, 1987

    PubMed  CAS  Google Scholar 

  • Konig P. Spacer devices used with metered-dose inhalers, breakthrough or gimmick? Chest 88: 276–284, 1985

    Article  PubMed  CAS  Google Scholar 

  • Krop HD, Block AJ, Cohen E. Neuropsychologic effects of continuous oxygen therapy in chronic obstructive pulmonary disease. Chest 64: 317–322, 1973

    Article  PubMed  CAS  Google Scholar 

  • Kueppers F, Black LF. Alpha-1-antitrypsin and its deficiency. American Review of Respiratory Disease 110: 176–194, 1974

    PubMed  CAS  Google Scholar 

  • Laforce FM, Eickhoff TC. Pneumococcal vaccine: the evidence mounts. Annals of Internal Medicine 104: 110–112, 1986

    PubMed  CAS  Google Scholar 

  • Lakshminarayan S. Ipratoprium bromide in chronic bronchitis/ emphysema: a review of the literature. American Journal of Medicine 81 (Suppl. 5A): 76–80, 1986

    Article  PubMed  CAS  Google Scholar 

  • Lakshminarayan S, Sahn SA, Weil JV. Effect of aminophylline on ventilatory responses in normal man. American Review of Respiratory Disease 117: 33–38, 1978

    PubMed  CAS  Google Scholar 

  • Larsson S, Svedmyr N. Bronchodilating effect and side effects of beta-2-adrenoreceptor stimulants by different modes of administration (tablets, metered aerosol, and combinations thereof). American Review of Respiratory Disease 116: 861–869, 1977

    PubMed  CAS  Google Scholar 

  • Leech JA, Gervais A, Ruben FL. Efficacy of pneumococcal vaccine in severe chronic obstructive pulmonary disease. Canadian Medical Association Journal 136: 361–365, 1987

    PubMed  CAS  Google Scholar 

  • Lightbody IM, Ingram CG, Legge JS, Johnston RN. Ipratropium bromide, salbutamol and prednisolone in bronchial asthma and chronic bronchitis. British Journal of Diseases of the Chest 72: 181–186, 1978

    Article  PubMed  CAS  Google Scholar 

  • MacNee W, Connaughton JJ, Rhind GB, Hayhurst MD, Douglas NJ, et al. A comparison of the effects of almitrine or oxygen breathing on pulmonary artery pressure and right ventricular ejection fraction in hypoxic chronic bronchitis and emphysema. American Review of Respiratory Disease 134: 559–565, 1986

    PubMed  CAS  Google Scholar 

  • Mahler DA. The role of theophylline in the treatment of dyspnea in COPD. Chest 92: 2S–6S, 1987

    PubMed  CAS  Google Scholar 

  • Mandella LA, Manfreda J, Warren CPW, Anthonisen NR. Steroid response in stable chronic obstructive pulmonary disease. Annals of Internal Medicine 96: 17–21, 1982

    Google Scholar 

  • Matthay RA. Favorable cardiovascular effects of theophylline in COPD. Chest 92: 22S–26S, 1987

    PubMed  CAS  Google Scholar 

  • Medical Research Council Working Party. Long-term domiciliary oxygen therapy in chronic hypoxic cor pulmonale complicating chronic bronchitis and emphysema. Lancet 1: 681–686, 1981

    Google Scholar 

  • Melot C, Naeije R, Rothschild T, et al. Improvement in ventilation-perfusion matching by almitrine in COPD. Chest 83: 528–533, 1983

    Article  PubMed  CAS  Google Scholar 

  • Morse JO. Alpha-1-antitrypsin deficiency. New England Journal of Medicine 299: 1045–1048; 1099–1105, 1978

    Article  PubMed  CAS  Google Scholar 

  • Nicotra MB, Rivera M, Awe RJ. Antibiotic therapy of acute exacerbations of chronic bronchitis. Annals of Internal Medicine 97: 18–21, 1982

    PubMed  CAS  Google Scholar 

  • Nocturnal Oxygen Therapy Trial Group. Continuous or nocturnal oxygen therapy in hypoxemic chronic obstructive lung disease: a clinical trial. Annals of Internal Medicine 93: 391–398, 1980

    Google Scholar 

  • Pardy RL, Rivington RN, Despas PJ, Macklem PT. Respiratory muscle training compared with physiotherapy in chronic airflow limitation. American Review of Respiratory Disease 123: 421–425, 1981

    PubMed  CAS  Google Scholar 

  • Parker JO, Ashekian PB, DiGiorgi S, West RO. Hemodynamic effects of aminophylline in chronic obstructive pulmonary disease. Circulation 35: 365–372, 1967

    Article  PubMed  CAS  Google Scholar 

  • Patriarca PA, Weber JA, Parker RA, Hall WN, Kendal AP, et al. Efficacy of influenza vaccine in nursing homes. Journal of the American Medical Association 253: 1136–1139, 1985

    Article  PubMed  CAS  Google Scholar 

  • Persson CGA, Erjefalt I, Karlsson J-A. Adenosine antagonism, a less desirable characteristic of xanthine asthma drugs? Acta Pharmacologica Toxicologica 49: 317–320, 1981

    Article  CAS  Google Scholar 

  • Rebuck AS, Chapman KR, Abboud R, Pare PD, Kreisman H, et al. Nebulized anticholinergic and sympathomimetic treatment of asthma and chronic obstructive airways disease in the emergency room. American Journal of Medicine 82: 59–64, 1987

    Article  PubMed  CAS  Google Scholar 

  • Rebuck AS, Slutsky AS. Acute respiratory failure in chronic obstructive pulmonary disease. In Geiger SR (Ed.) Handbook of physiology, pp. 771–791, American Physiological Society, 1986

  • Rice KI, Leatherman JW, Duane PG, Snyder LS, Harmon KR, et al. Aminophylline for acute exacerbations of chronic obstructive pulmonary disease. Annals of Internal Medicine 107: 305–309, 1987

    PubMed  CAS  Google Scholar 

  • Saah AJ, Neufeld R, Rodstein M, LaMontagne JR, Blackwelder WC, et al. Influenza vaccine and pneumonia mortality in a nursing home population. Archives of Internal Medicine 146: 2353–2357,1986

    Article  PubMed  CAS  Google Scholar 

  • Sackner MA, Chapman GA, Dougherty RD. Effects of nebulized ipratropium bromide and atropine sulfate on tracheal mucous velocity and lung mechanics in anesthetized dogs. Respiration 34: 181–185, 1977

    Article  PubMed  CAS  Google Scholar 

  • Schneider NG, Jarvik ME, Forsythe AB, Read LL, Elliott ML, et al. Nicotine gum in smoking cessation: a placebo-controlled, double-blind trial. Addictive Behaviors 8: 253–261, 1983

    Article  PubMed  CAS  Google Scholar 

  • Shim C, Stover DE, Williams Jr MH. Response to corticosteroids in chronic bronchitis. Journal of Allergy and Clinical Immunology 62: 363–367, 1978

    Article  PubMed  CAS  Google Scholar 

  • Shim CS, Williams Jr MH. Aerosol beclomethasone in patients with steroid-responsive chronic obstructive pulmonary disease (COPD). American Journal of Medicine 78: 655–658, 1985

    Article  PubMed  CAS  Google Scholar 

  • Sonne LJ, Davis JA. Increased exercise performance in patients with severe COPD following inspiratory resistive training. Chest 81: 436–439, 1982

    Article  PubMed  CAS  Google Scholar 

  • Tasaka K. Formoterol: a new orally active and selective β2-receptor stimulant. Drugs of Today 22: 505–519, 1986

    CAS  Google Scholar 

  • Tashkin DP, Ashutosh K, Blecker ER, Britt EJ, Cugell DW, et al. Comparison of the anticholinergic bronchodilator ipratropium bromide with metaproterenol in chronic obstructive pulmonary disease. American Journal of Medicine 81 (Suppl. 5A): 81–90, 1986

    Article  PubMed  CAS  Google Scholar 

  • Tiep BL, Belman MJ, Mittman C, Phillips R, Otsap B, et al. A new pendant storage oxygen-conserving nasal cannula. Chest 87: 381–383,1985

    Article  PubMed  CAS  Google Scholar 

  • Timms RM, Khaja FU, Williams GW, the NOTT Group. Hemodynamic response to oxygen therapy in chronic obstructive pulmonary disease. Annals of Internal Medicine 102: 29–36, 1985

    PubMed  CAS  Google Scholar 

  • Wewers MD, Gadek JE, Keogh BA, Fells GA, Crystal RG, et al. Evaluation of danazol therapy for patients with PiZZ alpha-1-antitrypsin deficiency. American Review of Respiratory Disease 134: 476–480, 1986

    PubMed  CAS  Google Scholar 

  • Williams Jr JH, Moser KM. Pneumococcal vaccine and patients with chronic lung disease. Annals of Internal Medicine 104: 106–109, 1986

    PubMed  Google Scholar 

  • Williams S, Seaton A. Intravenous or inhaled salbutamol in severe acute asthma? Thorax 32: 555–558, 1977

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Respiratory Medicine, Suite 4-009, Edith Cavell Wing, Toronto Western Hospital, 399 Bathurst Street, Toronto, Ontario, M5T 2S8, Canada

    Steven Kesten &  Anthony S. Rebuck

Authors
  1. Steven Kesten
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anthony S. Rebuck
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kesten, S., Rebuck, A.S. Management of Chronic Obstructive Pulmonary Disease. Drugs 38, 160–174 (1989). https://doi.org/10.2165/00003495-198938010-00007

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00003495-198938010-00007

Keywords

Search

Navigation