Chronic Obstructive Pulmonary Disease: Diagnosis and Treatment

Diagnosis

• A history and physical examination are the first steps in evaluating COPD.
• Pulmonary function testing is the most reliable diagnostic test. It can identify diminished lung function even before symptoms begin and can be used to follow the progression of the disease.
  
  For this test, the patient breathes into a spirometer machine, which measures the speed and strength of the moving air. The result can diagnose COPD and distinguish patients who have lung obstruction, as occurs in chronic bronchitis, from lung restriction, as occurs in emphysema.
• Chest X–rays are usually normal until late in the course of disease.
• Blood testing is necessary during flare–ups.

Treatment

• Acute flare–ups of COPD can be medical emergencies and may require hospitalization. It is important to identify and treat the cause of the flare–up, which is often a respiratory infection. Supplemental oxygen and medications to widen the airways (e.g., bronchodilators, such as albuterol) are the foundation of treatment. In severe flare–ups, intubation may be necessary.
  
• Quitting smoking is essential at any stage of the disease. Although lung damage will not be reversed (especially in advanced cases), smoking cessation will lead to improvements in lung function.
• Respiratory therapy and pulmonary rehabilitation have been shown to improve quality of life and exercise capacity.
  
• Physical exercise, as part of a pulmonary rehabilitation program, is essential. Exercise programs do not necessarily increase lung function, but they increase patients’ ability to perform activities of daily living. Respiratory muscle training in particular is associated with significant improvements in lung capacity and function and decreased shortness of breath. As with other forms of exercise, benefits are lost if patients do not maintain their efforts.
• Continuous or nighttime supplemental oxygen provides relief of symptoms and improves mortality.
• As the disease progresses, various medications are needed to reduce lung inflammation, widen the airways, and reduce airway obstruction.
  
  Bronchodilators (e.g., albuterol) and anticholinergic medications (e.g., ipratropium) are the most commonly used medications. However, some COPD patients do not respond to these agents.
  
  The role of steroids is still under investigation. Inhaled steroids are often prescribed but have not been shown to be beneficial in most patients. Oral steroids may help hospitalized patients with acute flare–ups.
  
  Antibiotics are also used during flare–ups.
  
• Surgery, which may include lung transplantation, is sometimes necessary in patients with advanced COPD.