A STEP CARE APPROACH TO MANAGING COPD

The management of patients with chronic obstructive pulmonary disease (COPD) is often complex but may be conceptualized into three steps. St ep 1 entails smoking cessation and preventive vaccinations. Step 2 uti lizes bronchodilators (anticholinergics, beta-adrenergic agonists, and methylxanthines). Step 3 employs corticosteroids. To these steps, adj unctive therapy may be added. Although the management of patients with COPD must be individualized, a stepwise approach offers a convenient guide and checklist for clinicians involved in a disease management ap proach to patient care.