After the diagnosis of COPD is established, education about the disease should be undertaken, so that the patient has a better understanding of the illness and can take an active role in its management. Smoking cessation should be emphasized and demanded. Pharmacotherapy is recommended in patients who are symptomatic. It should be instituted in a stepwise fashion according to the severity of symptoms and airway obstruction. In mild disease with only intermittent symptoms, inhaled } -agonists can be used on an as-needed basis. If the symptoms are more persistent, inhaled ipratropium bromide should be added on a regular basis. In more advanced disease stages with increasing symptoms, progressive addition of inhaled } -agonists (used on a regular basis or as long-acting preparations) and theophylline may be helpful. Dosage of these medications should be adjusted to minimize side effects. With severe disease and continued symptoms, a trial of inhaled or systemic corticosteroids is indicated.
During acute exacerbations, a short course of high-dose corticosteroids should be considered. Long-term systemic corticosteroids should only be used in the sickest patients who fail to respond to all other therapy and have shown objective improvement with this therapy. Antibiotics should be used early when a respiratory infection develops, and influenza and pneumo-coccal vaccines should be given routinely to all COPD patients.
If excessive secretions are present, measures to mobilize them, such as chest physiotherapy, can be instituted. Long-term oxygen therapy is indicated in COPD patients with hypoxemia. A pulmonary rehabilitation program is indicated in those patients who remain symptomatic and are restricted in their daily activities despite maximal pharmacotherapy and other treatment for their disease. Close attention to psychosocial problems and their appropriate treatment is also important in the overall medical management of patients with COPD.
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