ATS standards for the optimal management of chronic obstructive pulmonary disease

Tobacco smoking is the main cause of chronic obstructive pulmonary disease (COPD), and the provision of encouragement and support in smoking cessation is the best way to help patients with COPD. The three major goals of COPD management are to lessen airflow limitation, to prevent and treat secondary medical complications and to decrease respiratory symptoms and improve quality of life. Outpatient pharmacotherapy should be organized in a stepwise manner according the severity of disease, the aims being to induce bronchodilation, reduce inflammation and facilitate expectoration, although the role of anti-inflammatory and mucolytic treatment in COPD has not been clearly established. Patients who are not well controlled on optimal pharmacotherapy are candidates for enrollment in a pulmonary rehabilitation programme. Correction or prevention of hypoxaemia is a priority, and long-term oxygen therapy may prolong survival in hypoxaemic patients. With only limited data on criteria for hospital admission and the objectives of hospitalization, the published ATS standards on the management of COPD include expert consensus statements on these aspects of hospital care. Special considerations, such as surgery in the COPD patient, sleep disorders, nutrition, air travel, and ethical issues, are discussed.