Management of chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is characterised by insidiously progressive airflow limitation. The necessarily multifactorial management programme should include smoking cessation, prevention of infections, bronchodilator and steroid therapy, supplemental oxygen, physical therapy, pulmonary rehabilitation programmes, psychosocial support and treatment of concomitant disease. There have been many advances in medical therapy but some of the notorious controversies remain. New sympathomimetic agents and methylxanthines, as well as the availability of inhaled anticholinergic medications free of toxicity, have led to improvement in symptoms and complications related to COPD. There is a clear place for the judicious use of systemic steroids.