Treatment for Stable COPD

This chapter outlines the current therapeutic strategy for the management of chronic obstructive pulmonary disease (COPD) patients who are "stable," that is in their usual state of health. While the current therapies available to treat so-called stable COPD only partially meet therapeutic goals, these therapies can often offer considerable benefit. It is likely that many patients with COPD, however, are undiagnosed and even those with a diagnosis are inappropriately under treated. The medications used to treat patients with COPD are, in many cases, identical to those used to treat patients with asthma. The strategy for the use of these medicines, however, differs importantly between COPD and asthma. Effective patient management, therefore, requires that the clinician make an appropriate diagnosis, accurately stage the severity of disease in an individual patient, and define clearly therapeutic goals. Airflow limitation is a characteristic feature of both asthma and COPD. In asthma, the airflow limitation is generally reversible either spontaneously or with treatment. In COPD, in contrast, there may be some degree of reversibility, but expiratory airflow limitation, to some extent, is always present. Appropriate management of the COPD patient, therefore, requires an accurate assessment of disease stage and, as is increasingly recognized, thorough diagnosis of co-morbidities. Current staging of COPD depends on quantitative assessment of expiratory airflow to grade disease severity. Pulmonary rehabilitation, which does not improve lung function, likely improves both exercise tolerance and dyspnea, in part, because it permits COPD patients to exercise with less tachypnea and, therefore, with less dynamic hyperinflation. Current guidelines do not recommend any specific bronchodilator as being superior as an initial therapeutic choice.