Advances in the outpatient management of chronic obstructive pulmonary disease

Abstract

Chronic obstructive pulmonary disease (COPD) remains highly prevalent, underdiagnosed, and a major cause of morbidity and mortality. Disease rates and cost of care continue to rise annually in the United States and worldwide. Recent years have seen advances in our understanding of COPD as a heterogenous disease with distinct phenotypes. It is increasingly recognized that COPD severity and impact is complex and is inadequately described by airflow obstruction alone. The revised 2011 GOLD guidelines now incorporate multidimensional measures of symptom burden, functional limitations, and exacerbation frequency in patient assessment. Moreover, COPD is commonly associated with multiple medical co-morbidities that also have an impact on the symptom burden, disease severity, and mortality for individual patients. This conceptual frame-shift to recognition of COPD as a heterogenous and multifaceted disease with varying impact on the patient has begun to revolutionize the way COPD care is approached in the outpatient setting. Current management guidelines now emphasize broader-based patient assessment including characterization of patients' phenotypes, symptom burden, functional limitations, exacerbation risk, and co-morbidities to guide therapeutic interventions. Although some forms of therapy continue to be applicable to all patients with COPD, others seem to only benefit patients with selected disease phenotypes. Here we explore some of the recent advances in outpatient COPD management. We consider the varying manifestations of COPD, treatment approaches that remain broadly applicable, as well as selected phenotype-specific treatments, interventions targeted at reducing exacerbations, and management of intractable symptoms. We also suggest areas for future exploration. Copyright © 2013 by Lippincott Williams & Wilkins.