Treatment for Chronic Obstructive Lung Disease

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Oxygen Replacement. Oxygen replacement is an important component in most COLD treatments. It is the only treatment known to improve survival in COLD patients. The patient is assessed for specific timing and needs.

Surgery. If the patient no longer responds to medications, then surgery may be an option for some patients. Choices may include bullectomy, lung reduction, or lung transplantation.

General Guidelines for Treating Acute Exacerbations

Doctors recommend the following treatments for patients who need to be hospitalized:

• Supplemental oxygen, either mechanical or through noninvasive positive pressure ventilation, should be given.
• Bronchodilators; an inhaled or nebulized (see Administering Inhaled Drugs, below) beta2-agonist, with an anticholinergic agent added if the patient does not respond. Theophylline is not recommended, because it provides very little benefit, and carries a risk of serious side effects.
• Antibiotics if there are signs of infections, particularly if the acute exacerbation is very severe. Courses are usually 5 to 10 days.
• Corticosteroids are usually given for up to 2 weeks (oral corticosteroids in most cases, intravenous in severe cases). An important 2003 study indicated that relapse rates were significantly reduced when the patient also took oral corticosteroids in combination with antibiotics and bronchodilators for 10 days after the episode.
• Chest therapy may be helpful in some patients.

It is not always clear what triggers acute exacerbation episodes, so treatment can be controversial. Bacteria are obvious suspects, but because COLD patients commonly harbor bacteria, it has been difficult to determine which or even whether organisms are responsible. One 2002 study suggested that some episodes may be caused by changes in the strains of bacteria that are commonly present rather than an introduction of a new bacteria. In other cases, viruses and atypical bacteria may be responsible. In some acute exacerbations, however, no sign of infection is present. As with asthma, an inflammatory response in the airways unrelated to infection may suddenly cause changes that bring on an attack (although it is likely to be different from this response in asthma patients). In any case, even minor obstruction in the airways may be able to produce an acute exacerbation.