Outpatient management

of severe COPD
Dennis E. Niewoehner, M.D

Clinical problem

Chronic
Progressive
Insidious
complications

Strategies and evidence

History and physical examination
History : increasing age, dysonea linked
to activity, cigarette smoking, chronic
Physical examination : barrel chest,
hoovers sign, longer expiratory phase

Spirometry and other testing

 Smoking cessation
Slowing the decline in lung function, reducing
mortality rate

Bronchodilators
LABA such as salmeterol or formeterol: similiar
benefit in increasing respiratory status
SABA is prefered in emergency
Teophyline : poorly tolerated in older patient

Inhaled corticosteroid
Reducing frequency of exacerbation, even better
when combined with LABA

 Oxygen
Increasing quality of life
Absolute reduction in rate of death

Management of exacerbation
Antiobiotic: reducing exacerbation
Immunization

Pulmonary rehabilitation
Reverse muscular and cardiovasular
dysfunction through an individually designed
program.

 Surgical options
Resection of severely emphysematous
tissue improved lung function but not
in mortality rate
Lung transplantation

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