Out-patient management of asthma & COPD

Carefully document smoking history and other environmental exposures such as may occur in the work place. Also seek possible "triggers" such as household pets, ASA NSAIDs, and Beta Blockers. Laboratory evaluation should include a chest x-ray, ECG and Spirometry. If FEV1, sec less than 1 liter obtain ABGs. Treatment can be initiated with ipratroprium and prn use of Beta agonists. Theophyline may be useful. Corticosteroids may be effective in approximately 20% of subjects with stable COPD (nonasthmatic) and should be tried if symptom relief unsatisfactory and strongly urged before initiation of chronic O2 therapy. The role of inhaled steroids in COPD has not been adequately studied. Chronic O2 therapy in appropriate subjects may prolong life. Antibiotics are commonly prescribed for acute exacerbations of COPD, but without good supporting data. Corticosteroids, however, for acute exacerbations of COPD have been shown to be effective.