Management of Chronic Obstructive Pulmonary Disease

• Published in: The New England journal of medicine Vol. 350; no. 26; pp. 2689 - 2697
• Main Authors: Sutherland, E. Rand, Cherniack, Reuben M
• Format: Journal Article
• Language: English
• Published: Boston, MA Massachusetts Medical Society 24.06.2004
• Subjects: Administration, Inhalation; Adrenal Cortex Hormones - therapeutic use; Adrenergic beta-Agonists - therapeutic use; Algorithms; Biological and medical sciences; Bronchodilator Agents - therapeutic use; Chronic obstructive pulmonary disease, asthma; Drug Therapy, Combination; General aspects; Humans; Medical sciences; Physical Therapy Modalities; Pneumology; Pneumonectomy; Prognosis; Pulmonary Disease, Chronic Obstructive - diagnosis; Pulmonary Disease, Chronic Obstructive - therapy; Respiratory Function Tests; Severity of Illness Index; Theophylline - therapeutic use; Medicine; Lung disease; Chronic; Clinical management; Treatment; Respiratory disease; Bronchus disease; Obstructive pulmonary disease
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJMra030415

The goals of therapy for chronic obstructive pulmonary disease include relieving symptoms, improving abnormal physiology, and limiting complications, including abnormal gas exchange and exacerbations of the disease. This review summarizes current guidelines and provides recommendations for management, including assessment of lung function, preventive measures, stepwise medical therapy, and pulmonary rehabilitation and surgical therapy. By the time this disease becomes symptomatic, the forced vital capacity of most patients has already declined by about 50 percent. This review summarizes current guidelines and provides recommendations on management. Chronic obstructive pulmonary disease (COPD) is a syndrome of progressive airflow limitation caused by chronic inflammation of the airways and lung parenchyma. 1 The primary physiological abnormality in COPD is an accelerated decline in the forced expiratory volume in one second (FEV 1 ) from the normal rate in adults over 30 years of age of approximately 30 ml per year to nearly 60 ml per year. 2 As shown in Figure 1, the disease course begins with an asymptomatic phase in which lung function deteriorates without associated symptoms. The onset of the subsequent symptomatic phase is variable but often does not occur . . .