Management of Stable COPD
Phase 4 - Preventing Non-COPD Complications of Therapy

Patients using long-term corticosteroids or with reduced mobility or advancing age are at risk for compression fractures due to accelerated osteoporosis. A good anti-osteoporosis program should include: exercise (simple walking is best); corticosteroid dose reduced to as low as possible, substituting inhaled corticosteroids if effective; calcium supplements; estrogen supplements if appropriate (consider the use of progesterone if clinically indicated); and etidronate (400 mg q.d. for two weeks, every three months for two years) for patients who are unable to reduce their prednisone dose to less than 20 mg every other day or who are otherwise at high risk for osteoporosis.

Patients with COPD benefit from a good nasal hygiene program, especially if they use a nasal cannula for oxygen therapy. The use of nasal saline lavage, inhaled nasal corticosteroids, and increased humidification can help patients who experience increased nasal congestion. Decongestants containing pseudoephedrine and guaifenesin are well tolerated when topical measures do not control rhinorrhea or congestion.

Review the patient's medication list to see if any obvious drugs are contributing to their symptoms. Check the theophylline blood level (the goal is 8 to 12 µg/ml) if a patient is exhibiting clinical signs of toxicity (gastrointestinal symptoms, tremor, headache, tachycardia), or when adding another possible metabolic side effects such as hyperglycemia, hypokalemia, or azotemia when a change in the patient's clinical condition occurs or when initiating corticosteroid or diuretic therapy.

Recognize and treat depression and marked anxiety, which frequently accompany COPD. It helps to discuss this openly with the patient and their family and consider a psychiatric referral when simple measures (counseling, improving exercise and sleep routines, and maximizing pulmonary function) do not help control the patient's symptoms. Patients with stable COPD tolerate antidepressant therapy quite well, but most often depression is relieved when their “airflow obstruction” and “anxiety” are treated. Consider the use of alprazolam (0.25 mg q 6 h) or lorazepam (0.5 mg to 1.0 mg q 6 h to 8 h) in patients with disabling panic disorder that accompanies their COPD. Avoid overusing tranquilizer medications. They can affect mental acuity or cause excessive drowsiness. Encourage patients to avoid the regular use of hypnotic medications.