Management of Stable COPD
Conclusion

The earlier the diagnosis of COPD, the longer the preservation of lung function. This underscores the need for office spirometry to make an early diagnosis. The primary care physician can, through careful interest and perseverance, help patients with more advanced COPD deal with their chronic disability. An emphasis on smoking cessation, compliance with medication programs, exercise, and oxygen therapy when necessary will in most cases improve–and often stabilize–pul-monary function. Most often, patients will “plateau” and will experience long periods between “relapses” or exacerbations. These plateaus are very gratifying to patients, their families, and the physician and clinic staff.

When interviewing patients, look for certain symptoms (such as increased dyspnea, cough, fever, edema, or fatigue) that might suggest a nonspecific exacerbation of their COPD. The practitioner becomes very sensitive to changes in a patient's condition. Increased depression, fatigue, a change in sleep habits, decreased appetite, or other unexplained symptoms may in fact be the clinical manifestations of a deterioration in pulmonary function. A brief physical examination focusing on the work required by breathing and the appearance of the patient, brief spirometric recordings and oximetry readings, or a change on the patient’s chest x-ray frequently give clues about the patient's clinical deterioration. These same details can suggest changes in the patient’s medication program that might prevent hospitalization and further deterioration in pulmonary function.

References

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Petty TL (Chairman). Nocturnal Oxygen Therapy Trial Group, (nott). Continuous or nocturnal oxygen therapy in hypoxemic chronic obstructive lung disease. A clinical trial. Ann Intern Med 1980;93:391-398. This multicenter trial demonstrated improved survival with continuous oxygen therapy provided by an ambulatory system compared with nocturnal oxygen delivered from a stationary system.

Petty TL, Bliss PL. Ambulatory oxygen therapy, exercise, and survival with advanced COPD. Respir Care 2000;45:204-211. This retrospective analysis of survival and hospitalizations revealed that ability to increase exercise and receiving ambulatory oxygen resulted in better outcomes compared with patients who had less ability to exercise and who received oxygen from a stationary source.