Chronic obstructive airway diseases. Current concepts in diagnosis and comprehensive care

Abstract

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.

A Study of Short-Term Effect of Rehabilitative Therapy in Chronic Obstructive Pulmonary Disease

“…Chronic airway obstruction is one of the most relevant health problems in industrial world [5,11,12,21]. The real efficacy of the therapeutical measures usually em ployed is still discussed [6,14,19,24], The studies reporting the clinical effect of 'com prehensive' programs of treatment including medical therapy and respiratory rehabilita tion techniques have given different results [9, 10,17,18,20].…”

Tolerance of Chronic Dyspnea Using a Hypnoeducational Approach: A Case Report

“…With this information the patient felt assured that "hypnosis worked." ACOSTA-AUSTAN Conclusion Medical investigators have reported that patients with COPD have a reduction in thoracic and diaphragmatic motion which is often compromised further during periods of anxiety (Hodgkin et al, 1975;Faulkner, 1941). The consequence of this action exacerbates the existing work of breathing and creates a sense of suffocation.…”

Anxiety sensitivity and ventilator weaning: A preliminary analysis

“…Respiratory disorders that may precipitate acute respiratory failure and the subsequent need for mechanical ventilation support include COPD, pneumonia, asthma, bronchitis, bronchiolitis, and emphysema (Hodgkin et al, 1975;Lightowler, Wedzicha, Elliott, & Ram, 2003). Although psychological factors have been implicated in ventilator weaning success based on clinical observations, there has been very limited study.…”

“…There is long-standing recognition, based on clinical observation and limited empirical work, that patients with chronic respiratory disorders (e.g., emphysema, asthma, chronic bronchitis) experience significant distress in association with dyspnea (Hodgkin et al, 1975). Indeed, guidelines for the comprehensive treatment of chronic obstructive airway disorders, published more than 25 years ago, included recommendations for relaxation exercises (Hodgkin et al, 1975).…”

“…Indeed, guidelines for the comprehensive treatment of chronic obstructive airway disorders, published more than 25 years ago, included recommendations for relaxation exercises (Hodgkin et al, 1975). Congruent with these recommendations, recent studies of patients with respiratory disease revealed high prevalence rates of panic disorder (Carr, Lehrer, Rausch, & Hochron, 1994;Yellowlees, Haynes, Potts, & Ruffin, 1988).…”