[Means and organisation of the management of severe forms of COPD]

Chronic obstructive pulmonary disease is becoming the 3rd aetiology of death by disease. In its advanced presentation, it generates a chronic respiratory failure with hypoxia and frequent hypercapnia. Its complex management implies at that stage a medical treatment, physiotherapy and pulmonary rehabilitation, associated with long-term oxygentherapy. In the most severe stages, may be discussed long-term home mechanical ventilation with non invasive connection in order to avoid tracheotomy and to prevent acute respiratory episodes leading these patients in intensive care units and yet responsible for 15 000 deaths per year in our country.