Resp Care
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Review Historical Article
Surgical options for patients with COPD: sorting out the choices.
Surgical procedures designed to improve pulmonary function and quality of life of patients with advanced emphysema have been attempted for more than a century. Of the many attempted procedures, only giant bullectomy, lung transplantation, and lung-volume-reduction surgery have withstood the test of time and are currently being practiced. This article reviews each of these procedures and also develops a rational approach to selecting appropriate candidates for these 3 interventions.
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Inhaled aerosol drugs commonly used by patients with chronic obstructive pulmonary disease include short-acting and long-acting bronchodilators, as well as corticosteroids. These agents are available in a variety of inhaler devices, which include metered-dose inhalers (MDI), breath-actuated MDIs, nebulizers, and, currently, 5 different models of dry powder inhaler (DPI). There is evidence to suggest that multiple inhaler types cause confusion among patients and increase errors in patient use. ⋯ Important features identified by patients for an ideal inhaler are ease of use during an attack, dose counter, and general ease of use and learning. A breath-actuated-pMDI, such as the Autohaler, ranked at the top of inhaler preference in a study of 100 patients with airflow obstruction, compared to DPIs and MDIs. Short of a universal simple inhaler, patient and caregiver education remains the best solution to correct patient errors in use.