Chapter

Chronic medical therapy and the GOLD guidelines

Miguel Carrera, Ernest Sala and Alvar GN Agustí

in Chronic Obstructive Pulmonary Disease (COPD)

Published on behalf of Oxford University Press

ISBN: 9780199549146
Published online May 2011 | e-ISBN: 9780199607273 | DOI: http://dx.doi.org/10.1093/med/9780199549146.003.0006

Series: Oxford Respiratory Medicine Library

Chronic medical therapy and the GOLD guidelines

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• Active reduction of risk factors and bronchodilator treatment are central to the management of COPD. • Regular use of long-acting bronchodilators (β2-agonists and antimuscarinics) is more effective than short-acting bronchodilators in patients with persistent symptoms. • Inhaled corticosteroids (ICS) combined with bronchodilators are indicated in patients with forced expiratory volume in 1s FEV1 < 50% predicted and repeated exacerbations. • Influenza vaccination is indicated for all COPD patients; while pneumococcal vaccine is recommended for COPD patients older than 65 years, and in those younger with FEV1 < 40% predicted. • Antibiotics should only be used for infectious exacerbations of COPD, while N-acetylcysteine only affects the frequency of exacerbations in patients off inhaled corticosteroids. • Mucolytic agents, antitussives, and vasodilators are not recommended in stable COPD. • All COPD patients benefit from exercise training programmes, while long-term oxygen therapy increases survival in COPD patients with chronic respiratory failure.

Chapter.  2560 words.  Illustrated.

Subjects: Respiratory Medicine and Pulmonology

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