Management of chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) is a major cause of mortality and morbidity throughout the world. It is the only cause of death among the top 10 causes that is increasing and is expected to become the third leading cause of death in the world by 2020. A diagnosis of COPD should be considered in any patient with previous exposure to risk factors for the disease and/or the presence of chronic cough, sputum production, or dyspnea. Patients with COPD are categorized into five stages based on their pulmonary function tests and symptoms. Smoking cessation is the single most effective way to halt the progression of COPD and prolong life. Pharmacological management of stable COPD includes the use of bronchodilators (beta2 agonists, anticholinergics and methylxanthines) and inhaled corticosteroids. Other adjunctive measures include vaccination, oxygen therapy, pulmonary rehabilitation, and certain surgical measures like bullectomy and lung transplantation. Management of acute exacerbations includes the use of systemic steroids, antibiotics, bronchodilators, and oxygen therapy. During very severe exacerbations, patients may need ventilatory support.