MANAGEMENT 1997 OF CHRONIC OBSTRUCTIVE PULMONARY-DISEASE

COPD is a disorder characterized by expiratory flow limitation that do es not change markedly over periods of several months' observation. Wh en the diagnosis is suspected, COPD patients should be submitted to fu ll assessment and initiation of therapy. Initial assessment includes a complete history, a detailed physical examination, pulmonary function tests, a chest X-ray, and blood tests. Therapy of COPD aims at reduci ng symptoms, preventing exacerbations and preserving optimal lung func tion. Many COPD patients have a bronchospastic component and usually s how some response to bronchodilator therapy. Anticholinergics, pl-agon ists or theophylline are used as monotherapy or in combination. A subg roup of patients with COPD may benefit from oral long-term corticoster oid therapy. At prime diagnosis of COPD, a trial of oral steroid under optimal bronchodilator therapy is warranted in order to identify ster oid responders early in the course of the disease. Stopping smoking is the most effective preventive measure and should be combined with com plementary approaches such as eviction of environmental irritants, vac cines and prescription of antioxidants. Long-term oxygen therapy is be neficial in chronically hypoxemic patients. Respiratory rehabilitation uses a multidisciplinary approach aiming at decreasing dyspnea, incre asing exercise tolerance and improving quality of life. Nocturnal home noninvasive mechanical ventilatory assistance can improve arterial bl ood gas tensions in patients with respiratory failure, but the long-te rm effect on survival is still under investigation. In selected patien ts, surgery (bullectomy, lung volume reduction, lung transplantation) may greatly improve pulmonary function.