[Smokers with chronic bronchitis and emphysema. Utilize the entire therapy spectrum!]

In the majority of cases, chronic obstructive bronchitis is due to inhalative cigarette smoking. Not only does it cause high costs, but it also has a poor prognosis. The pathogenesis of the illness is now considered to be chronic, mainly neutrophilic, inflammation of the airways and the peripheral parts of the lungs--chronic hypersecretion is a common feature of the disease. Successful treatment requires the giving up of inhalative cigarette smoking. Pharmacological options include anticholinergics, beta sympathomimetics, theophylline and inhalative or systemic corticosteroids. Long-acting beta sympathomimetics such as formoterol, and salmeterol, and still experimental long-acting parasympatholytics, represent significant advances. Such additional measures as vaccination, long-term administration of oxygen and, more recently, surgical procedures such as lung volume reduction to treat severe pulmonary emphysema are described.