The COPD patient must stop smoking.

Drugs

Infections can worsen COPD; therefore antibiotics are used during flare-ups of symptoms. Antibiotics are generally used only for acute flare-ups. Patients who experience frequent flare-ups with purulent sputum (a sign of infection) during the year may be placed on a schedule of prophylactic (preventative) treatment with antibiotics the first 10 days of each month. This is done for special cases only.

Surgery

Lung Volume Reduction Surgery In lung volume reduction surgery (LVRS), the upper portions of the diseased lungs are removed. Although the procedure improves symptoms and lung function for some patients, the reasoning is not understood. It is predicted that the chest wall and breathing muscles return to a place of mechanical advantage. Or it is possible that the elastic recoil of the lungs improves as a result. Currently there is a large multi-center study being performed to determine the benefits of surgery and how to qualify candidates for the procedure. The percentage of patient that currently met the criteria is very low with only 20%-40% of patients qualify.

Lung Transplantation In some of the most severe cases of COPD a single or double lung transplantation may be an option. The criteria to be selected varies from hospital to hospital.

Medication Nebulizer

Bronchodilators and Anti-inflammatory Agents Pharmacological treatment involves m edications used to relax the muscle bands that tighten around the airways during an asthma episode (bronchodilators) . Bronchodilators also help clear mucus from the lungs. Some examples of bronchodilators are: beta2 agonists, anticholinergics, and theophylline. In addition to bronchodilators, anti-inflammatory drugs such as corticosteroids can be used. These are most effective when inhaled. There are several delivery methods for inhaled medications , including metered-dose inhalers, breath-actuated inhalers, dry powder inhalers, and nebulizers.

The beta2 agonists relax the smooth muscle thereby decreasing bronchoconstriction and airflow obstruction. They also improve the ability to clear mucus and the endurance of fatigued respiratory muscles. Theophylline is a bronchodilator and an anti-inflammatory agent and is available in pill form or given through an I.V. while hospitalized. Theophylline can cause your airways to relax and open, making it easier to breathe. It can also improve the diaphragm’s ability to contract and increase the clearance of mucus and phlegm. Corticosteroids are often used to treat inflamed airways, but the long-term benefit is not clear. Steroids have not been shown to slow lung decline in COPD. They may reduce the number of flare-ups and improve symptoms in some patients, but there is no convincing evidence to support this. Approximately 10%-15% of COPD patients have a measurable response to corticosteroid therapy. Three mucolytic medications may benefit some patients: guaifenesin, potassium iodide, and N-acetylcysteine. A lot of effort has been put into developing medications (mucolytics) that break up and allow mucus to be cleared more effectively from the airways. Unfortunately, this has met with only very modest success.

Oxygen

Oxygen is the only treatment that has been shown to improve survival. Oxygen is used if your lung function is impaired and your body can no longer absorb enough oxygen from the air. Indications for oxygen therapy include: arterial oxygen pressure is less than 55 mm Hg, or an oxygen saturation of 88% with arterial oxygen pressure of 55-59 mm Hg, or an oxygen saturation of 89% accompanied by cor pulmonale (right-sided heart failure), or polycythemia (proportion of red blood cells above 56% of blood sample).

A patient who does not qualify for oxygen as described may need oxygen while sleeping or exercising. Oxygen may be used at night only if the oxygen pressure at night is less than 55 mm Hg or the oxygen saturation is less than 88%. If the oxygen pressure is less than 55 mm Hg or the oxygen saturation is less than 88% during exercise, oxygen may be prescribed.

Nasal cannula is the most commonly used oxygen delivery system and is usually attached to an oxygen concentrator (not portable) or an E cylinder (portable). There are several oxygen-conserving devices used with these systems.