Outpatient management of chronic obstructive pulmonary disease

The outpatient management of chronic obstructive pulmonary disease (COPD) i s designed to limit the decline in respiratory function over time, to relie ve the symptoms and improve the patient's functional status, and to manage complications when they arise. Factors that predispose to airway inflammati on, including cigarette smoking and respiratory infections, are prevented b y behavioral modification programs, measures such as exercise and nutrition to improve general health, and regular vaccination. Symptoms are relieved by bronchodilator and antiinflammatory therapy, based upon the specific nee ds of the patient. Hypoxemia and acute infections are treated with oxygen a dministration and the use of antibiotics when necessary. The management of acute exacerbations of COPD is addressed elsewhere in this symposium (ie, c hoice of antibiotics is not discussed here). Also, certain aspects of manag ement, such as surgical procedures, chest physical therapy, and other aspec ts of pulmonary rehabilitation, are also subjects of subsequent articles in this series. Although none of these modalities, except for smoking cessati on and oxygen administration, have been shown to alter the course of COPD, the careful choice of the therapeutic measures discussed here can lead to s ignificant relief of symptoms in the patient with chronic airway obstructio n.