The Medical clinics of North America
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Med. Clin. North Am. · Jul 2012
ReviewAn integrated approach to the medical treatment of chronic obstructive pulmonary disease.
COPD is a treatable condition for which careful and objective evaluation of patients’ lung function, symptoms, exercise capacity, and exacerbation history on an ongoing basis is essential so that treatments may be individualized as much as possible. Although the comparative effectiveness of drug classes has not yet been tested completely in COPD, virtually all inhaled COPD therapies improve lung function, quality of life, and reduce COPD exacerbations, which fulfills the major goals of care. Pulmonary rehabilitation is safe, effective, and a crucial component of COPD therapy. Newer therapies have been developed with the specific purpose of reducing COPD exacerbations and should be prescribed to individuals who have evidence of recurrent exacerbations despite maximal inhaled maintenance medications.
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The stair-climbing test, 6MWT, and shuttle test are exercise tests that requires less technical support than the CPET and are more available to any physician. The 6MWT is the simplest and most likely to be cost effective, as it provides useful information regarding prognosis, ADLs, and health care use at a very low cost. In addition, the 6MWT can be used to evaluate response to several interventions, including physical rehabilitation, medications, lung volume reduction interventions, and transplantation. ⋯ The role of exercise as a therapeutic tool is central to the concept of pulmonary rehabilitation. Exercise training improves not only functional dyspnea and health-related quality of life, but also has been shown to decrease health care resource use. As part of a comprehensive pulmonary rehabilitation initiated after a hospitalization for exacerbation, it has been shown to decrease readmission rates.
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Although there are nonmodifiable genetic risk factors for COPD, most known risk factors for development and progression of COPD can be corrected. Continued efforts to encourage smoking cessation and measures to reduce exposure to SHS, outdoor air pollution, biomass smoke, and occupational and related amateur exposures will have a significant impact on worldwide health.
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Med. Clin. North Am. · Jul 2012
ReviewThe importance of the assessment of pulmonary function in COPD.
Spirometry is the gold standard for making the diagnosis of COPD. It should be performed in every case of suspected COPD. Other pulmonary functions, such as lung volumes, can give insight into physiologic consequences of COPD, such as hyperinflation. Pulmonary function testing can also aid in assessing the severity of disease and in managing the disease after diagnosis is made.
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Chronic obstructive pulmonary disease is a heterogeneous condition of the lungs and body. Techniques in chest imaging and quantitative image analysis provide novel in vivo insight into the disease and potentially examine divergent responses to therapy. ⋯ Following an explanation of the technique, each section details some of the useful information obtained with these examinations. Future clinical care and investigation will likely include some combination of these imaging modalities and more standard assessments of disease severity.