CHRONIC OBSTRUCTIVE PULMONARY-DISEASE - A RGENTINE CONSENSUS

Several meetings of chest specialists were held in order to update bas ic knowledge on Chronic Obstructive Pulmonary Disease (COPD) and to es tablish guidelines regarding its prevention and treatment. This Consen sus was prompted by the important morbidity and mortality due to COPD. Pulmonary emphysema, chronic bronchitis and asthma may evolve into CO PD when developing chronic, persistent, non reversible airflow obstruc tion. Its pathologic features, physiopathology, pulmonary function der angements and clinico-radiological picture are summarized. Early detec tion and prevention accomplished through smoking cessation are essenti al to stop health damage due to this condition. Strategies directed to smoking cessation are described. Once COPD is established, inhaled br onchodilators (IB) -anticholinergics, beta-2 agonists or both- might b e useful. Teophylline is indicated additionally when no improvement is obtained with IB. Inhaled steroids (IE) may stop progression of airwa ys obstruction; they are recommended in patients who remain symptomati c and/or with severe airflow obstruction (FEV1 less than 50% predicted ) despite treatment with beta-2 adrenergics and teophylline. Vaccinati on against influenza and pneumococcal pneumonia is suggested. Other me dications (antibiotics, psychoactive drugs, alpha-1 antitrypsine, resp iratory stimulants) or surgical interventions, including lung transpla ntation, might be of help in certain circumstances. In patients with p hysiotherapy, supplementary nutrition, muscle retraining, prolonged ox ygen therapy and, eventually, noninvasive mechanical ventilation might improve survival and quality of life. Acute decompensations leading t o respiratory failure should be promptly detected and treated with oxy gen, IB, teophylline, corticosteroids, antibiotics and, eventually, me chanical ventilation. The main role of public education in disease pre vention is emphasized. Moreover, patient and family education is essen tial for adequate treatment of COPD.