[Diagnosis and management of chronic obstructive pulmonary disease]

Chronic obstructive pulmonary disease (COPD) is defined by the presence of airflow limitation, measured by the forced expiratory volume in 1 second (FEV1) after the administration of bronchodilator. Here the beta2-reversibility is defined by postbronchodilator FEV1-prebronchodilator FEV1 > 12% of pre-bronchodilator FEV1. The simple classification of disease severity into 4 stages is recommended based postbronchodilator FEV1. Bronchodilator medications are central to the symptomatic management of COPD. The principal bronchodilator treatments are beta2-agonists, anticholinergics, theophylline, and a combination of these drugs. Treatments including inhaled glucocorticosteroids are recommended to only severe COPD patients with the FEV1 < 50% predicted and to those who repeat exacerbations. Inhaled bronchodilators and systemic glucocorticosteroids are effective treatments for exacerbations of COPD. Noninvasive intermittent positive pressure ventilation in acute exacerbations reduces mortality, decreases the need for invasive mechanical ventilation and intubation, and decreases the length of hospital stay.