Medical Management of Emphysema and Chronic Obstructive Pulmonary Disease



Chronic obstructive pulmonary disease (COPD) is a disease process characterized by the presence of airflow obstruction secondary to emphysema or chronic bronchitis. It is this airflow obstruction that is the main culprit for the various symptoms manisfested by COPD patients. Consequently, one of the main objectives of medical treatment in COPD is to reduce airflow obstruction, which may be accompanied by airway hyperreactivity and, therefore, be partially reversible. Thus, bronchodilators are employed in the treatment of COPD. Furthermore, smoking cessation is the only currently available intervention that may slow progression of this disease. Besides pharmacotherapy, other medical treatments, such as oxygen therapy and pulmonary rehabilitation, have been proven to be beneficial to patients with COPD. Prevention and treatment of infection also plays an important role in reducing the frequency of acute exacerbations in these patients. Emphysema and chronic bronchitis usually coexist to different degrees in COPD patients (1). Pharmacologic treatment of airflow obstruction is less effective in emphysema. This is because airflow limitation as a result of loss of elastic recoil in emphysema is irreversible. Because of the lack of effective medical therapy in severe emphysema, surgical interventions, such as lung volume reduction surgery (LVRS) and lung transplantation, are being explored as alternative treatment options in selected cases. Still, much can be done for most COPD patients by employing appropriate medical management techniques.


Chronic Obstructive Pulmonary Disease Chronic Obstructive Pulmonary Disease Patient Acute Exacerbation Fluticasone Propionate Airflow Obstruction 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Burrows B, Bloom JW, Traver GA, et al. (1987) The course and prognosis of different forms of chronic airways obstruction in a sample from the general population. N Engl J Med 317: 1309–1314.PubMedCrossRefGoogle Scholar
  2. 2.
    Make B (1994) Collaborative self-management strategies for patients with respiratory disease. Respir Care 39: 566–579.PubMedGoogle Scholar
  3. 3.
    Anthonisen NR, Connett JE, Kiley JP, et al. (1994) Effects of smoking intervention and the use of an inhaled anticholinergic bronchodilator on the rate of decline of FEV 1: The Lung Health Study. JAMA 272: 1497–1505.PubMedCrossRefGoogle Scholar
  4. 4.
    McCarthy DS, Craig DB, Cherniack RM (1976) Effect of modification of the smoking habit on lung function. Am Rev Respir Dis 114: 103–113.PubMedGoogle Scholar
  5. 5.
    Ferguson GT, Cherniack RM (1993) Management of chronic obstructive pulmonary disease. N Engl J Med 328: 1017–1022.PubMedCrossRefGoogle Scholar
  6. 6.
    Santa Cruz R, Landa J, Hirsch J, et al. (1974) Tracheal mucous velocity in normal man and patients with obstructive lung disease: effects of terbutaline. Am Rev Respir Dis 109: 458–463.Google Scholar
  7. 7.
    Gross NJ (1988) Ipratropium bromide. N Engl J Med 319: 486–494.PubMedCrossRefGoogle Scholar
  8. 8.
    Kirsten DK, Wegner RE, Jorres RA, Magnussen H (1993) Effects of theophylline withdrawal in severe COPD. Chest 104: 1101–1107.PubMedCrossRefGoogle Scholar
  9. 9.
    Wanner A (1985) Effects of methylxanthines on airway mucociliary function. (1985) Am J Med 79: 16–21.PubMedCrossRefGoogle Scholar
  10. 10.
    Matthay RA, Berger HJ, Davies R, et al. (1982) Improvement in cardiac performance by oral long-acting theophylline in chronic obstructive pulmonary disease. Am Heart J 104: 1022–1026.PubMedCrossRefGoogle Scholar
  11. 11.
    Dowell AR, Heyman A, Sieker HU, et al. (1965) Effect of aminophylline on respiratory center sensitivity in Cheyne-Stokes respiration and in pulmonary emphysema. N Engl J Med 273: 1447–1453.PubMedCrossRefGoogle Scholar
  12. 12.
    Mendella LA, Manfreda J, Warren CPW, et al. (1982) Steroid response in stable chronic obstructive pulmonary disease. Ann Intern Med 96: 17–21.PubMedGoogle Scholar
  13. 13.
    Callahan CM, Dittus RS, Katz BP (1991) Oral corticosteroid therapy for patients with stable chronic obstructive pulmonary disease. Ann Intern Med 114: 216–223.PubMedGoogle Scholar
  14. 14.
    Weir DC, Gove RI, Robertson AS, et al (1990) Corticosteroid trials in non-asthmatic chronic airflow obstruction: a comparison of oral prednisolone and inhaled beclomethasone dipropionate. Thorax 45: 112–117.PubMedCrossRefGoogle Scholar
  15. 15.
    Thompson AB, Mueller MB, Heires AJ, et al. (1992) Aerosol beclomethasone in chronic bronchitis; Improved pulmonary function and diminished airway inflammation. Am Rev Respir Dis 146: 389–395.PubMedCrossRefGoogle Scholar
  16. 16.
    Paggiaro PL, Dahle R, Bakran I, et al. (1998) Multicentre randomised placebo-controlled trial of inhaled fluticasone propionate in patients with chronic obstructive pulmonary disease. International COPD Study Group. Lancet 351: 773–780.PubMedCrossRefGoogle Scholar
  17. 17.
    Wise RA, ConnettJE, Weinmann G, et al. (2000) Effect of inhaled trinamcinolone on the decline in pulmonary function in Chronic Obstructive Pulmonary Disease. The Lung Health Study Research Group. N Engl J Med. 343: 1902–1909.CrossRefGoogle Scholar
  18. 18.
    Konstan MW, Stern RC, Doershuk CF (1994) Efficacy of the FLUTTER device for airway mucus clearance in patients with cystic fibrosis. J Pediatr 124: 689–693.PubMedCrossRefGoogle Scholar
  19. 19.
    Clarke SW, Thomson ML, Pavia D (1980) Effect of mucolytic and expectorant drugs on tracheobronchial clearance in chronic bronchitis. Eur J Respir Dis 110 (Suppl): 179–191.Google Scholar
  20. 20.
    Tamaoki J, Chiyotani A, Kobayashi K, et al. (1992) Effect of indomethacin on bronchorrhea in patients with chronic bronchitis, diffuse panbronchiolitis or bronchiectasis. Am Rev Respir Dis 145: 548–552.PubMedCrossRefGoogle Scholar
  21. 21.
    Marom ZM, Goswami SK (1991) Respiratory mucus hypersecretion (bronchorrhea): A case discussion-possible mechanism(s) and treatment. J Allergy Clin Imm uno l 87: 1050–1055.CrossRefGoogle Scholar
  22. 22.
    Recommendation of the Immunization Practices Advisory Committee (1989) Pneumococcal polysaccharide vaccine. MMWR 38: 64–76.Google Scholar
  23. 23.
    Medical Research Council Working Party (1981) Long-term domiciliary oxygen therapy in chronic hypoxic cor pulmonale complicating chronic bronchitis and emphysema. Lancet 1: 681–686.Google Scholar
  24. 24.
    Nocturnal Oxygen Therapy Trial Group (1980) Continuous or nocturnal oxygen therapy in hypoxemic chronic obstructive lung disease. Ann Intern Med 93: 391–398.Google Scholar
  25. 25.
    O’Donohue WJ Jr (1992) Transtracheal oxygen: A step beyond the nasal cannula for long-term oxygen therapy. Nebr Med J 77: 291–295.PubMedGoogle Scholar
  26. 26.
    Hodgkin JE (1990) Pulmonary rehabilitation. Clin Chest Med 11: 447–460.PubMedGoogle Scholar
  27. 27.
    Niederman MS, Clemente PH, Fein AM, et al. (1991) Benefits of a multidisciplinary pulmonary rehabilitation program: Improvements are independent of lung function. Chest 99: 798–804.PubMedCrossRefGoogle Scholar
  28. 28.
    Light RW, Muro JR, Sato RI, et al. (1989) Effects of oral morphine on breathlessness and exercise tolerance in patients with chronic obstructive pulmonary disease. Am Rev Respir Dis 139: 126–133.PubMedCrossRefGoogle Scholar
  29. 29.
    Britton JR, Pavord ID, Richards KA, et al. (1995) Dietary antioxidant vitamin intake and lung function in the general population. Am J Respir Crit Care Med 151: 1383–1387.PubMedCrossRefGoogle Scholar
  30. 30.
    Celli BR, Snider GL, Heffner J, et al. (1995) Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 152 (suppl): S77 - S121.CrossRefGoogle Scholar
  31. 31.
    Keenan SP, Kernerman PD, Cook DJ, et al. (1997) Effect of noninvasive positive pressure ventilation on mortality in patients admitted with acute respiratory failure: a meta-analysis. Crit Care Med 25: 1685–1692.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2002

Authors and Affiliations

There are no affiliations available

Personalised recommendations