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Management of stable chronic obstructive pulmonary disease

Authors
Gary T Ferguson, MD
Barry Make, MD
Section Editor
James K Stoller, MD, MS
Deputy Editor
Helen Hollingsworth, MD

INTRODUCTION

Chronic obstructive pulmonary disease (COPD) is a common condition with a high and continually increasing mortality, affecting men and women equally. It is estimated that approximately 7 percent of all individuals have COPD, including approximately 10 percent of individuals 65 years of age or older [1-3]. The true prevalence is likely higher because COPD is both under-recognized and under-diagnosed. COPD is the third leading cause of death among adults in the US and is expected to become the third leading cause of death worldwide by 2020 [4,5].

The management of stable COPD will be reviewed here. The clinical manifestations, evaluation, diagnosis, natural history, risk factors, comorbidities, and prognosis of COPD, the management of refractory COPD, and treatment of acute exacerbations are discussed separately. (See "Chronic obstructive pulmonary disease: Definition, clinical manifestations, diagnosis, and staging" and "Chronic obstructive pulmonary disease: Prognostic factors and comorbid conditions" and "Chronic obstructive pulmonary disease: Risk factors and risk reduction" and "Management of refractory chronic obstructive pulmonary disease" and "Management of exacerbations of chronic obstructive pulmonary disease".)

GENERAL APPROACH

We share the philosophy of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) that pharmacologic and nonpharmacologic therapies should be guided, in part, by disease severity, but the aim of therapy is to improve patient symptoms, decrease exacerbations, and improve patient function and quality of life [3]. Non-pharmacologic interventions include: (1) smoking cessation, (2) reduction of other risk factors (eg, exposure to open cooking fires), (3) vaccinations, (4) oxygen therapy, and (5) pulmonary rehabilitation.

In the following sections, various pharmacologic therapies for COPD and the clinical evidence for each therapy are reviewed. Pharmacotherapy is generally added in a stepwise fashion, depending upon the level of symptoms, risk of exacerbations, and response to therapy (table 1). However, for patients who present with more severe disease, a stepwise approach may not always be the best choice, as it may be necessary to initiate several medications at once to achieve appropriate symptom and exacerbation control. An approach to the management of patients with stable COPD is outlined below. (See 'Summary and recommendations' below.)

The mainstays of drug therapy of stable symptomatic COPD are inhaled bronchodilators (beta agonists and anticholinergics) given alone or in combination with inhaled glucocorticoids. These are generally administered via hand held inhalation in the form of metered dose, soft mist, or dry powder inhalers, although some patients may benefit from therapy administered by nebulization.

                                           
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Literature review current through: Oct 2017. | This topic last updated: Nov 17, 2017.
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