74 PART II: PRIMARY CARE DISORDERS
ersaged65yearsor younger with an FEV
percent of the predicted value. All patients, regardless of
age, should receive the annual inuenza vaccination.
55–60 mm Hgwith polycythemia,pulmonary hyperten-
rently available agent that reduces mortality in patients
-antitrypsin augmentation is available and rec-
as bullectomy, lung-volume reduction surgery, and lung
transplantation, are reserved for select patients.
Acute exacerbations of COPD can occur at any time
Although they can
be triggered by noninfectious irritants, they are generally
caused by an infectious organism, usually a bacteria or
include Streptococcus pneumoniae, Haemophilus inﬂuenzae,
and Moraxella catarrhalis.Atypicalorganismsmayalsobe
responsible to a lesser degree.
inammation-induced bronchial wall brosis causes fur-
an eosinophilic inammatory response in the bronchial
airways that is typical to asthma and partially reversible
with pharmacologic agents.
Exacerbations of COPD can
anticholinergics, oral corticosteroids, and, in the case of
bacterial infection, appropriate antibiotic therapy.
airway hyperresponsiveness, inammation, and varying
degrees of reversible and nonreversible airow obstruc-
tion, depending on the chronicity of the disease.
Asthma is a very common chronic disease, affecting
and slightly higher in females after age 14 years.
of cases it begins before the age of 10 years with a peak
incidence at age 3 years.
Although the prevalence for
asthma remains high, the proposed widespread use of
matic attacks and associated mortality.
status, previous life-threatening asthma attacks, and
improper use of or lack of proper medications.
gers, is the basis of physiologic changes within the airway
constriction, airway edema, airway hyperresponsiveness,
Lifestyle Changes: Practical Tips for Your
ing disease progression; preventing infections; and
improving breathing, exercise tolerance, nutrition,
and mood. The most important lifestyle change a
patient with COPD can make is to abstain from
function decline slows. Another lifestyle change
includes the prevention of infections and other air-
obtaining vaccinations that prevent respiratory disease,
as previously described.
Improvements in respiration can be attained by
learning breathing techniques, such as pursed lip
Those with excessive sputum production should
maintain adequate hydration through drinking u-
ids and home humidication. Chest therapy that
Physical exercise improves whole body health
and strength. Pulmonary rehabilitation is a great
option for patients because it incorporates not only
monary rehabilitation is not an option, walking,
Maintenance of good nutrition is important in
a high-fat protein diet with fewer carbohydrates is
recommended. Good nutrition in obese patients is
and overall health. Foods rich in antioxidants have
Social and emotional support should be encour-
aged because patients who cope with this lifelong