Respiratory therapy. Current practice in ambulatory patients with chronic airflow obstruction

The role of respiratory therapy in treating ambulatory patients with chronic obstructive pulmonary disease is becoming more clearly defined. Oxygen therapy on a continuous basis is needed for patients with arterial PO2 values below 45 mm Hg and should be considered for patients with arterial PO2 values between 45 and 55 mm Hg who have chronic cor pulmonale, erythrocytosis with hematocrit value greater than 55%, and disturbances of cognition and sleep. Concentrated bronchodilator and corticosteroid aerosols have established roles in therapy; the place of bland aerosols is less clear They may increase ease of expectoration and should be given by simple compressed-air nebulizer systems; their administration by brief periods of intermittent positive-pressure breathing is rarely justified. Three-positional, postural drainage with chest percussion and vibration may be helpful in mobilizing secretions in patients with severe disease.