Treatment

Stopping Smoking and Healthy Lifestyle. Stopping smoking is the first and primary step to treating COLD and slowing its progression. In addition, all patients should maintain a healthy diet rich in fruits and vegetables. An exercise program may be useful, particularly if it is tailored to improve lung function.

Pulmonary Rehabilitation Programs. Patients with COLD need to be very active in managing their condition. Patients might check with their physicians to determine whether a pulmonary rehabilitation program would be appropriate, if one were available in their area. Such programs are conducted by a team of health professionals to improve lung function. It involves medical treatments, exercise, breathing retraining, and psychological interventions, when needed. If available and affordable, it can be extremely effective, particularly after acute exacerbations, for improving symptoms, exercise capacity, quality of life, and mood. Patients with severe COPD may benefit from programs that last at least six months.

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Medications for Managing Chronic COLD. A major goal with the use of medications for COLD is to prevent acute exacerbations, which can hasten deterioration of lung function. The main treatment strategy employs a stepped approach with the use of increasingly potent medications depending on the patient's response:

• Beta 2 agonists and anticholinergics, classes of drugs known as bronchodilators, open the airways in the lungs and are the cornerstone of COLD drug therapy. In a major analysis, long-acting beta 2 agonists and anticholinergics were most effective and reduced exacerbation rates by 20% to 25%.
• Inhaled corticosteroids also reduce exacerbations by up to 25%. Studies are mixed on whether long-term use improves lung function, and these agents may also have some adverse effects with long-term use. Inhalers that combine a long-acting beta 2 agonists and a corticosteroid (Advair, Seretide, Symbicort) are even more effective than either agent alone---reducing exacerbations by 30%. Some studies suggest they may offer significant improvements in lung function and even improve survival rates, but more research is needed to confirm such findings.
• Antibiotics are sometimes used preventively, but they seem to have only a small effect in reducing illness days. Experts do not recommend them routinely.

An inhaler is a quick way of administering medicine directly into the bronchial passageways to promote clearer breathing.