Chronic Obstructive Lung Disease Medications

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Many hospitals offer these programs, which are led by a team of health professionals. Pulmonary rehabilitation can also be done in the home or community. The treatment is tailored to individual patients, but usually includes:

• Breathing training
• Disease education
• Exercise (endurance and resistance training)
• Nutritional advice
• Psychological assessment

Patients are usually assessed at the beginning and end of the program. Programs generally last 6 - 12 weeks, but longer programs appear to provide more long-term benefits. In one study, an 8-week pulmonary rehabilitation program reduced the number of COPD patients admitted to the hospital by 46%. Maintenance programs may slightly improve long-term outcomes.

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Exercise. Exercise is important for maintaining strength and endurance, both of which are greatly affected by COPD. Weight-bearing exercises are important for maintaining quality of life and the ability to live independently. For the greatest benefit, programs should combine low- and high-intensity exercise with strength and endurance training. The use of noninvasive ventilation (NIPPV) during exercise provides some small, very short-term benefit. Receiving supplemental oxygen during rehabilitative exercise may improve patients' endurance. There is no evidence that inspiratory muscle training is effective during pulmonary rehabilitation.

Surgery. When a patient no longer responds to medications, surgery becomes a possible option. Choices include:

• Bullectomy
• Lung transplantation
• Lung volume reduction surgery (LVRS)

General Guidelines for Treating Acute Exacerbations

The goal of COPD treatment, in addition to providing symptom relief, is to prevent exacerbations. Each exacerbation causes lung function to decline. Bringing lung function back to its pre-exacerbation state can take 6 months. When exacerbations are frequent, lung function may never return to normal, and the patient's condition spirals downward.

Exacerbations are most commonly caused by bacterial or viral infections, or by air pollution. The cause is never identified in about one-third of patients.