ABSTRACT
This chapter reviews the treatment of chronic obstructive pulmonary disease (COPD) based on the pathophysiological alterations that occur in this disease. We do not intend for this chapter to substitute for formal, expertconsensus evidence-based guidelines for the treatment of COPD such as those that have been produced by the National Heart, Lung and Blood Institute (NHLBI)/World Health Organization (WHO) Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop (1) or the excellent systematic evidence-based reviews of the Cochrane Collaboration (2). Our intent is instead to organize the approach to the therapy of COPD based on an understanding of the biological and physiological abnormalities that characterize the disease. Therefore, the chapter addresses the use of bronchodilators in the context of airways reactivity, oxygen supplementation in the context of gas exchange abnormalities, antibiotics and the role of infection, and antiinflammatory treatments in the context of what is known about inflammatory changes in COPD. We point out important gaps in our knowledge to focus future research directions for the treatment of COPD.
