Chronic obstructive airway diseases. Current concepts in diagnosis and comprehensive care
J. E. Hodgkin, O. J. Balchum, I. Kass, E. M. Glaser, W. F. Miller, A. Haas, D. B. Shaw, P. Kimbel and T. L. Petty
Physicians and paramedical personnel often find the early diagnosis and
differentiation of obstructive airway diseases to be a challenging problem.
The history and physical examination are often not enough to allow the
physician to detect either the presence of, or determine the type of,
disease present. Patterns of pulmonary function abnormality to determine
the presence of obstructive or restrictive defects are discussed.
Guidelines useful in the differentiation of obstructive airway diseases are
presented. Once a patient with COAD is assessed, the physician needs to
outline a therapeutic program after establishing goals with the patient.
These goals include (1) improved ability for the patient to achieve relief
from symptoms and (2) improved capacity to carry out the activities of
daily living. The therapeutic modalities available for the comprehensive
care of patients with COAD are discussed. These include general factors
such as patient and family education, avoidance of smoking and other
inhaled irritants, avoidance of infection, a minimum stress environment,
high fluid intake, and proper nutrition. The appropriate use of the
medications most commonly employed in the teatment of these patients, eg,
bronchodilators, expectorants, antimicrobials, corticosteroids, cromolyn,
digitalis, and diuretics, are individually discussed. The use of such
respiratory therapy techniques as aerosol therapy, intermittent positive
pressure breathing, and oxygen therapy are considered. Application of the
specialty of rehabilitation medicine to patients with obstructive airway
disease is described. This includes physical therapy with breathing
retraining, clapping and postural drainage, and exercise reconditioning,
occupational therapy with attention to energy conservation in activities of
daily living, psychological considerations, and vocational rehabilitation.
Definite benefits that can be demonstrated if the physician employs this
type of systematic respiratory care program include a decrease in the
frequency and duration of hospital admissions, socioeconomic gains from
reduced hospitalizations, a reduction in anxiety, depression and somatic
concern, the return of patients to positions of employment and the
establishment of a better quality of life. Persistence in making sure the
patient continues in a systematic program, including both pharmacological
and nonpharmacological modalities, may be the means of assuring maintenance
or even improvement in his health. The day-to-day treatment for the
majority of patients should remain in the hands of the primary physician.
However, community resources must be established to allow the primary
physician to provide these patients with adequate comprehensive respiratory
care. Development of three levels of care (the primary physician, community
respiratory rehabilitation units, and the regional respiratory center)
should make superior respiratory care available to every patient with
obstructive airway disease.
