title: [Long-term treatment strategy in chronic obstructive pulmonary disease: how to change the course of the disease].
abstract: COPD is a pulmonary disease with a systemic impact. The goals of COPD assessment are to determine the severity of the disease to guide management. Smoking cessation is a prime objective at all the stages of the disease to modify the long-term decline in lung function, reduce the COPD symptoms, and the frequency of exacerbations, improve health status and reduce mortality. The bronchodilators are central in the pharmacologic management of COPD. Long-acting bronchodilators are indicated as maintenance treatment to relieve COPD symptoms (particularly dyspnea) despite regular use of short-acting bronchodilators. Long-acting bronchodilators reduce the exacerbation rate. The choice between a long-acting β2-adrenergic and an anticholinergic depends on the patient's perception of symptom relief. The inhaled corticoids are only indicated in COPD combined with long-acting β2-adrenergic in patients with severe COPD and a history of repeated exacerbations, who have significant symptoms despite therapy with bronchodilators. The combination of an inhaled corticosteroid with a long-acting β2-agonist reduces the exacerbation rate. The rehabilitation should be offered to all patients with dyspnea, exercise intolerance, or limitation in everyday activities related to COPD despite optimal pharmacological therapy and management of co-morbidities. Pulmonary rehabilitation is a multidisciplinary and tailored management of the COPD patients which enable to optimize exercise capacity, social reintegration, autonomy, reduce health care costs by decreasing the exacerbation rate, urgent visits and duration of hospitalisation. The rehabilitation is not just focusing on the improvement of exercise capacity, but also seeks sustained behavioural changes that are needed to achieve real improvement in health status and quality of life. Pulmonary rehabilitation is also an excellent opportunity for education which is critical in the healthcare pathway.
authors.affiliation: Hôpital Foch, UPRES EA 220, 92150 Suresnes, France. Electronic address: p.devillier@hopital-foch.org.
authors.forename: Philippe
authors.initials: P
authors.lastname: Devillier
authors.affiliation: Hôpital Foch, UPRES EA 220, 92150 Suresnes, France; Hôpital Foch, service de pneumologie, 92150 Suresnes, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Salvator
authors.affiliation: Université Paris Descartes (EA2511), AP-HP, groupe hospitalier Cochin, site HIA du Val de Grâce, service de pneumologie et soins intensifs respiratoires, 75005 Paris, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Roche
authors.affiliation: Hôpital Foch, UPRES EA 220, 92150 Suresnes, France.
authors.forename: Stanislas
authors.initials: S
authors.lastname: Grassin-Delyle
authors.affiliation: Hôpital Foch, UPRES EA 220, 92150 Suresnes, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Naline
authors.affiliation: Hôpital Foch, UPRES EA 220, 92150 Suresnes, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Dorocant
authors.affiliation: Hôpital Foch, service de pneumologie, 92150 Suresnes, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Neveu
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000318:Adrenergic beta-Agonists / Q000009:adverse effects / Q000627:therapeutic use; D001993:Bronchodilator Agents / Q000009:adverse effects / Q000627:therapeutic use; D018680:Cholinergic Antagonists / Q000009:adverse effects / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003299:Cooperative Behavior; D003692:Delayed-Action Preparations; D018450:Disease Progression; D006801:Humans; D033183:Interdisciplinary Communication; D008134:Long-Term Care / Q000379:methods; D029424:Pulmonary Disease, Chronic Obstructive / Q000145:classification / Q000175:diagnosis / Q000401:mortality / Q000534:rehabilitation*; D016540:Smoking Cessation; D015996:Survival Rate
chemical_list: D000305:Adrenal Cortex Hormones; D000318:Adrenergic beta-Agonists; D001993:Bronchodilator Agents; D018680:Cholinergic Antagonists; D003692:Delayed-Action Preparations