COPD

Q:What is the latest thinking on the use of dailyinhaled corticosteroids in the managementof chronic obstructive pulmonary disease (COPD)?

A:Theophylline remains useful in the maintenance management of COPD. It is most commonly prescribed as an adjunct to an inhaled β-agonist, ananticholinergic, or a combination of these agents.

Oral corticosteroids arecommonly used inambulatory patientsas short- or long-termtherapy for a numberof diseases. For example, patientswith acute exacerbations of asthmaor chronic obstructive pulmonary diseaseare routinely given 1- to 2-weekcourses of prednisone, methylprednisolone,or another oral corticosteroid.In addition, oral corticosteroidsare used as maintenance therapy inpatients with such conditions assystemic lupus erythematosus, sarcoidosis,and post-organ transplantcomplications.

Q:I am trying to encourage a patient with chronicobstructive pulmonary disease (COPD) to quitsmoking. He began smoking at age 14 years and hassmoked 1 pack of cigarettes a day for 35 years. His lungfunction is moderately decreased (forced expiratoryvolume in 1 second [FEV1], 65% of predicted). What othermeasures can I recommend to help restore lung functionso that he has more stamina and less shortness ofbreath on exertion?

An 82-year-old man suddenly became extremely short of breath while helpinghis wife wash dishes. The dyspnea was not accompanied by pain, and it was notrelieved by sitting. He was taken to the emergency department after diaphoresisand cyanosis developed.

Chronic obstructive pulmonary disease(COPD) is the fourth leadingcause of chronic morbidity and mortalityin the United States.1 Its prevalenceand impact are increasing,and the World Bank/World HealthOrganization has projected that it willrank fifth in 2020 as a global burdenof disease.2,3 The economic and publichealth impact of COPD is staggering,because this chronic conditionrequires long-term care, frequentoffice visits, and use ofemergency department and hospitalservices. Thus, there is a pressingneed to discover new therapies thatcontrol symptoms and prevent diseaseprogression.

Q:Is there a role for inhaled corticosteroids in chronic obstructivepulmonary disease (COPD)?

The goals of therapy in chronic obstructive pulmonary disease are to ameliorate symptoms, improve daily function, preserve lung function, identify and reduce exacerbations and, if possible, decrease mortality. A comprehensiveapproach that includes prevention, early identification, and pharmacotherapy-and oxygen therapy, pulmonary rehabilitation, and/or surgery when appropriate-can optimize patient outcomes.

Although the estimates of prevalence vary, there is convincing evidence that patients with chronic obstructive pulmonary disease (COPD) are at increased risk for depression. Moreover, depression has been associated with diminished functional status, increased symptoms, and increased mortality in patients with COPD. Encouraging news comes from Nguyen and Carrieri-Kohlman, who report that a dyspnea self-management program that includes exercise can reduce both dyspnea and depressed mood in these patients.

NPPV should be considered theventilatory modality of first choicein patients presenting to an acutecare hospital with an exacerbationof COPD. This is based on the findingsof multiple randomized controlledtrials as well as meta-analyses.These have shown that NPPVused in such patients brings about amore rapid improvement in dyspnea,vital signs, and PaCO2 thandoes oxygen therapy with standardmedical treatment. Use of NPPV resultsin significant reductions in theneed for intubation, morbidity andmortality rates, and in some studies,the length of hospital stay. These latterbenefits are unquestionably relatedto the avoidance of the complicationsof intubation, includingnosocomial infections, that increasein occurrence as the duration of intubationbecomes prolonged.

LOS ANGELES -- Patients with asthma and chronic obstructive pulmonary disease (COPD) receive only half the care that they should, according to a national sample.

SALT LAKE CITY -- Upgrading nebulizers to deliver less medicine less often saved staff time and overall costs without adverse effects on inpatients with chronic obstructive pulmonary disease, researchers reported here.

A 78-year-old woman requests evaluation of worsening dyspnea. A long-time smoker, she quit when chronic obstructive pulmonary disease (COPD) developed. At each of the last several visits, her hair had been uniformly white.

SALT LAKE CITY -- In what is being billed as a landmark trial, a combination of two drugs often used alone has increased survival, quality of life, and lung function in patients with chronic obstructive pulmonary disease, researchers said here.

JACKSONVILLE, Fla. -- Acid reflux atop chronic obstructive pulmonary disease is associated with twice as many COPD exacerbations a year compared with patients without acid reflux, researchers here said.

Approximately 90% of cases of lung cancer are attributable to smoking-either directly or as a result of passive exposure. Fifty percent of smokersdie of a smoking-related disease. The 4 most common causes of death-heartattack, lung cancer, chronic obstructive pulmonary disease, and stroke-areall associated with smoking. More lung cancer is diagnosed in former than incurrent smokers.1 The risk of lung cancer decreases each year following smokingcessation, but former heavy smokers will always have a higher risk thannonsmokers.

When a patient with chronic obstructive pulmonary disease (COPD) presents with what appears to be an acute exacerbation, you should consider the possibility of pulmonary embolism (PE). This is the message conveyed by a prospective cohort study in France.

As with any potential exposure, the initial approach should be to establish the patient's diagnosis before attempting to determine the effect of a potential exposure. The main differential diagnoses to consider for a patient who has cough and wheezing that may be associated with an exposure are asthma, chronic obstructive pulmonary disease, allergic rhinitis, and vocal cord dysfunction.

WINNIPEG, Manitoba -- Inhaled corticosteroids sharply reduce the risk of death from all causes for patients with chronic obstructive pulmonary disease (COPD), according to researchers here.

WINNIPEG, Manitoba -- Inhaled corticosteroids sharply reduce the risk of death from all causes for patients with chronic obstructive pulmonary disease (COPD), according to researchers here.

SAO PAULO, Brazil -- Women who are on long-term oxygen therapy for chronic obstructive pulmonary disease (COPD) are 54% more likely to die than men.

Over the past few decades, the management of chronic disease has assumed a greater role in health care. Diseases such as diabetes, chronic obstructive pulmonary disease, and depression have replaced acute disorders as the leading cause of morbidity, mortality, and health care expenditures.

Abstract: Tracheobronchomalacia is a form of expiratory central airway collapse characterized by softening of the airway wall cartilaginous structures. Symptoms often mimic asthma and chronic obstructive pulmonary disease. Pulmonary function test results may suggest a diagnosis, but findings are neither sensitive nor specific. Bronchoscopy and novel dynamic radiographic studies contribute to the diagnosis and help differentiate true malacia from other forms of expiratory central airway collapse. Treatment options include medication; noninvasive ventilatory support; interventional bronchoscopy with airway stent insertion; and open surgical procedures, such as tracheostomy, tracheal resection, and tracheoplasty. (J Respir Dis. 2006;27(8):327-335)

STANFORD, Calif -- Patients with chronic obstructive pulmonary disease (COPD) who used inhaled beta-2 agonists had more than twice the risk for respiratory death than those who used anticholinergic agents, according to investigators here.

Although the relationship is not completely understood, it is clear that anxiety and depression can adversely affect the course of asthma and chronic obstructive pulmonary disease.