Medical Health Encyclopedia

Oxygen Replacement. Oxygen replacement is an important component in most COLD treatments. In fact, it is the only treatment known to improve survival in COLD patients. The patient is assessed for specific timing and needs.

Surgery. If the patient no longer responds to medications, then surgery may be an option for some patients. Choices may include bullectomy, lung reduction, or lung transplantation.

General Guidelines for Treating Acute Exacerbations

Acute exacerbations are episodes in which airways suddenly become obstructed and symptoms worsen. In general, some expert groups recommend the following treatments for patients who need to be hospitalized:

• Supplemental oxygen.
• Bronchodilators. An inhaled or nebulized beta2 agonist, with an anticholinergic agent added if the patient does not respond. Consider oral or intravenous xanthines when the condition is very severe.
• Antibiotics if there are signs of infections, particularly if the acute exacerbation is very severe. (Courses are usually 5 to 10 days.)
• Corticosteroids (short term use of oral corticosteroids in most cases; intravenous in severe cases). An important 2003 study indicated that relapse rates were significantly reduced when the patient also took oral corticosteroids in combination with antibiotics and bronchodilators for 10 days after the episode.
• Noninvasive positive-pressure ventilation in patients at risk for respiratory failure.
• Chest therapy may be helpful in some patients.

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It is not always clear what triggers these episodes, so treatment can be controversial. Bacteria are obvious suspects, but because COLD patients commonly harbor bacteria, it has been difficult to determine which or even whether organisms are responsible. One 2002 study suggested that some episodes may be caused by changes in the strains of bacteria that are commonly present rather than an introduction of a new bacteria. In other cases, viruses and atypical bacteria may be responsible. In some acute exacerbations, however, no sign of infection is present. As with asthma, an inflammatory response in the airways unrelated to infection may suddenly cause changes that bring on an attack (although it is likely to be different from this response in asthma patients). In any case, even minor obstruction in the airways may be able to produce an acute exacerbation.

Treating Complications of Advanced COLD