An update on chronic obstructive pulmonary disease.
OBJECTIVE
Provide an update on the diagnosis and management of chronic obstructive pulmonary disease (COPD) based on new international and national guidelines. COPD affects approximately 5% to 7% of adults in the United States, with a higher prevalence in elderly persons (10% in elderly males).


METHODS
A Medline search of relevant articles and the Global Initiative for Obstructive Lung Disease and the American Thoracic Society/European Respiratory Society COPD Guidelines.


METHODS
Articles and current guidelines relevant to pharmacists working with COPD patients in extended-care facilities.


RESULTS
COPD is a chronically progressive disease that ultimately leads to major health impairment. New international and national guidelines recently have become available; these guidelines provide extensive insight into many aspects of the disease. Key interventions include early diagnosis, use of pulmonary-function testing, smoking cessation, supplemental oxygen, pulmonary rehabilitation, optimization of pharmacological therapies, and preventing--as well as minimizing--the impact of acute exacerbations of COPD. Optimizing the use of bronchodilators and, in selected patients, the use of corticosteroids are especially important pharmacological interventions in the management of COPD. Patients are started on short-acting bronchodilators; long-acting agents can be added and, in some patients, inhaled corticosteroids can be added as well. Other pharmacological interventions include smoking cessation therapies and the use of anti-infective and mucolytics/expectorants.


CONCLUSIONS
Pharmacists can assist in proper drug selection and administration in COPD patients in long-term care facilities. In addition, they can assist in preventing complications of drug therapy such as steroid-induced osteoporosis.
Pleasants
Roy A
RA
Division of Pulmonary and Critical Care Medicine, Duke University School of Medicine, Durham, North Carolina, USA. roypleasants@duke.edu
Haden
Douglas
D