Chronic airway obstruction

The initial diagnosis and evaluation of patients with chronic airway obstruction should include an assessment of the degree of pathophysiologic abnormality by means of pulmonary function tests and arterial blood gas analysis; a chest roentgenogram and an electrocardiogram provide information on the extent of parenchymal disease and its cardiac effects. The management of these patients should focus on measures to reduce airway irritation, prevent and treat pulmonary infections, and decrease the functional effects of the airway obstruction. Abstinence from cigarettes and the avoidance of air pollution such as working in dusty atmospheres would reduce continued airway irritation. Exacerbations due to pulmonary infections, most commonly due to Hemophilus influenzae and Streptococcus pneumoniae, require treatment with an appropriate antibiotic: ampicillin, amoxicillin, or trimethoprim sulfamethoxazole. Bronchodilator drug therapy should be used in patients who demonstrate some reversibility of airway obstruction; useful bronchodilator drugs include theophylline, metaproterenol, isoetharine, and terbutaline. A trial of steroid therapy may be indicated in some patients. The treatment of cor pulmonale requires adequate oxygenation and diuretic therapy; digoxin is not indicated, except for the treatment of arrhythmias.