Medical management of emphysema

In summary, this article attempted to provide a framework for the elaboration of a stepcare medical management plan for patients with COPD. An algorithm describing this approach is presented in Figure 1. Inhaled ipratropium bromide and beta 2-agonist are both effective bronchodilators and may be sufficient in mild disease. For patients with persisting limitation in daily activities, various combinations of beta 2-agonist, ipratropium bromide, and theophylline may be used to potentiate the efficacy of the treatment. If this proves insufficient, a trial of oral corticosteroids can then be instituted. Only those individuals with a reduction in airflow obstruction after this therapy are candidates to receive either low-dose oral or low-dose inhaled corticosteroids in order to maintain the improvement. Inhaled corticosteroids are of no clinical benefit to patients with advanced COPD unresponsive to oral corticosteroids. Arterial blood gas should be analyzed in patients with a FEV1 less than 50% of predicted value and oxygen therapy prescribed according to the prescription guidelines. Pulmonary rehabilitation is indicated in patients with reduced functional status, despite adequate drug treatment.