Resp Care
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Exacerbations of chronic obstructive pulmonary disease (COPD) cause morbidity, hospital admissions, and mortality, and strongly influence health-related quality of life. Some patients are prone to frequent exacerbations, which are associated with considerable physiologic deterioration and increased airway inflammation. About half of COPD exacerbations are caused or triggered primarily by bacterial and viral infections (colds, especially from rhinovirus), but air pollution can contribute to the beginning of an exacerbation. ⋯ A 2-week course of oral corticosteroids is as beneficial as an 8-week course, with fewer adverse effects, and might extend the time until the next exacerbation. Antibiotics have some efficacy in treating exacerbations. Exacerbation frequency increases with progressive airflow obstruction; so patients with chronic respiratory failure are particularly susceptible to exacerbation.
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The goals of managing chronic obstructive pulmonary disease include making the correct diagnosis, avoiding further risk (especially by smoking cessation), controlling symptoms (particularly dyspnea), and treating complications. Patients with chronic obstructive pulmonary disease can obtain substantial symptom relief from medications, including bronchodilators. Prescription of bronchodilators should be guided by the patient's degree of dyspnea, and response to initial therapy. ⋯ A collaborative self-management approach recognizes the patient's role in making his or her own health decisions and the physician's role as an educator and facilitator of the patient's health decisions. When multiple therapies are employed, a comprehensive management plan should be developed to help the patient understand and incorporate all the necessary treatments on an ongoing basis. Disease management programs may be useful in assisting health care practitioners and patients in managing chronic obstructive pulmonary disease.
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Chronic obstructive pulmonary disease is easily detected in its preclinical phase, using office spirometry. Successful smoking cessation prevents further disease progression in most patients. ⋯ Improvements in spirometry software have made it much easier to obtain good quality spirometry test sessions, thereby reducing the misclassification rate. Respiratory therapists and pulmonary function technologists can help primary care practitioners select good office spirometers for identifying chronic obstructive pulmonary disease and teach staff how to use spirometers correctly.
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Chronic obstructive pulmonary disease (COPD) continues to cause a heavy health and economic burden in the United States and around the world. Some of the risk factors for COPD are well known and include smoking, occupational exposures, air pollution, airway hyperresponsiveness, asthma, and certain genetic variations, although many questions remain, such as why < 20% of smokers develop substantial airway obstruction. There are several different definitions of COPD and the definitions depend on accurate diagnosis. ⋯ Furthermore, evidence continues to emerge that COPD represents several different disease processes, with potentially different interventions required. In most of the world COPD prevalence and mortality are still increasing and will probably continue to rise in response to increases in smoking, particularly by women and adolescents. Resources aimed at smoking cessation and prevention, COPD education, early detection, and better treatment will be of the most benefit in our continuing efforts against this important cause of morbidity and mortality.