An Integrated Approach to the Medical Treatment of Chronic Obstructive Pulmonary Disease

Asthma and COPD Program, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
The Medical clinics of North America (Impact Factor: 2.61). 07/2012; 96(4):811-26. DOI: 10.1016/j.mcna.2012.05.002
Source: PubMed


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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    ABSTRACT: Anxiety and depression are highly prevalent comorbid complications in COPD. Breathing techniques can improve anxiety and depression in subjects hospitalized due to COPD exacerbation. We conducted a randomized clinical study using two groups. The sample comprised 46 male patients aged 67-86 years hospitalized with acute COPD exacerbation. Patients were randomly and equally divided into the control and controlled breathing intervention groups.The sample comprised 46 male patients aged 67-86 years hospitalized with acute COPD exacerbation. Patients were randomly and equally divided into the control and controlled breathing intervention groups. Baseline and post-intervention recordings of Dyspnea, Anxiety and depression, Quality of life (SGRQ and EURQoL), Respiratory pressures (PImax-PEmax), Hand-grip test and Sleep quality were taken in all subjects. Subjects hospitalized due to acute COPD exacerbation showed high levels of dyspnea and low values in overall quality of life as measured with the St. George's Respiratory Questionnaire (SGRQ). Controlled breathing techniques had a significant effect on dyspnea, anxiety and mobility (p<0.05). All the measured areas were improved in the intervention group. The control group had poorer values in all the areas after the hospitalization period. Controlled breathing exercises benefit patients hospitalized due to COPD exacerbation in anxiety and depression values.
    07/2013; 59(2). DOI:10.4187/respcare.02565
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    ABSTRACT: Background The study aimed to compare the efficacy and safety of nebulized steroid (NS) with systemic corticosteroids (SC) and to determine optimal NS dose in the treatment of patients with COPD exacerbations requiring hospitalization. Material/Methods The study was a randomized, parallel design trial. Eligible patients (n=86) were randomly allocated to 1 of the 3 treatment groups: parenteral corticosteroid (PS) (n=33), 4 mg (NB) (n=27), or 8 mg NB (n=26). Partial pressure of arterial oxygen (PaO2), carbon dioxide (PaCO2), pH, and oxygen saturation (SaO2) were evaluated at baseline, 24 h, 48 h, and discharge. Airway obstruction (forced vital capacity [FVC] and forced expiratory volume 1 s [FEV1]) was evaluated at admission and discharge. Results There were no significant differences between the groups for all parameters at all time periods, except for higher FEV1 value in the 8-mg NB group at baseline. In groups, significant differences were determined for FVC, FEV1, PaO2, and SaO2 (p<0.001), but not for PaCO2 and pH, in comparison to their baseline values. As adverse events, hyperglycemia and oral moniliasis were observed in the PS group (n=4) and in the NB groups (n=5), respectively, and treatment change was required in 9 patients (2 patients in the PS group and 7 patients in the NB groups) (p=0.57). Conclusions Nebulized budesonide may be used as an alternative to SC because of its equal effectiveness and lesser systemic adverse effects. The choice of optimal dosage needs to be evaluated carefully because adverse effect and dropout rates varied according to dosage. However, there is a need for further studies including more severe cases and evaluating long-term outcomes or relapses comparing the 3 arms.
    Medical science monitor: international medical journal of experimental and clinical research 03/2014; 20:513-20. DOI:10.12659/MSM.890210 · 1.43 Impact Factor