COPD: primary care management with drug and oxygen therapies

Chronic obstructive pulmonary disease related in most cases to extensive cigarette smoking is a leading cause of morbidity and mortality among patients age 55 and older. Smoking cessation, inhaled anticholinergic therapy, and oxygen supplementation (when indicated) are primary treatment modalities. Nicotine administration via a transdermal system or polacrilex is the pharmacologic method of choice for smoking cessation. Concomitant group psychotherapy increases the likelihood of success. Beta agonists, mucolytics, and antibiotics can be useful in selected subgroups. Steroids and theophylline are controversial in COPD and should be used with caution. Prognostic indicators, such as degree of reversible airway disease, aid in long-term care decisions.