Pulmonary Rehabilitation Programs The main components of most pulmonary rehabilitation programs include endurance or exercise training, education, behavioral modification, and outcome assessment.
ÎAll patients benefit from exercise training programs, improving with respect to exercise tolerance, dyspnea and fatigue (A).
ÎEducation is most effective when it is interactive and conducted in small workshops (B).
Supplemental Long-Term Oxygen Therapy and Death
ÎThe long-term administration of oxygen (> 15 hours/day) to patients with chronic respiratory failure has been shown to increase survival (A).
Surgery
ÎIn carefully selected patients bullectomy is effective in reducing dyspnea and improving lung function (C).
ÎLung volume reduction surgery in patients with upper lobe emphysema increases PaO2
quality of life, reduces the frequency of COPD exacerbations, and decreases use of supplemental oxygen.
Table 2. Long-acting Medicationsa Generic (Brand) Anticholinergics
Dosage Form
Ipratropium (Atrovent ®
Tiotropium (Spiriva ®
)
PDE-4 inhibitor Roflumilast (Daliresp™
)
Arformoterol (Brovana® Aerolizer® )
Formoterol (Foradil®
(Perforomist®
Indacaterol (Arcapta™
Neohaler™ ) Salmeterol (Serevent Diskus®
Theophylline (Slo-Phyllin® Theolair®
, Uniphyl ® , Theo-24 ® , others) , ) ) HFA) MDI:
17 mcg/dose DPI:
18 mcg/dose 500 mcg tablet Solution
DPI: 12 mcg/single use capsule
Solution DPI: 75 mcg/capsule ) DPI: 50 mcg/blister Dose
2 inh qid Max dose: 12 inh/d
1 capsule daily with HandiHaler®
device 500 mcg daily Long-acting β2-agonists* (Alternative to increasing doses of, or as adjunct to, low to moderate
or higher doses of ICS. Used with, not in place of, anti-inflammatory agents, especially for nocturnal symptoms or to prevent exercise-induced bronchospasm.)
15 mcg/2 mL q12h by nebulization 1 capsule q12h
20 mcg bid by nebulization 1 capsule daily
1 blister q12h
Methylxanthines (alternative third-line agent). Serum monitoring is important. Maintain serum concentrations of 5-15 mcg/mL at steady state.
Liquids, sustained- release tablets, capsules Starting dose for children and adults
> 45 kg: 300-600 mg/day daily for 3 days; then 400-600 mg daily.
* BLACK BOX WARNING: Long-acting β2
related death. They should never be used alone in children or adults with asthma. Please see product labeling for information on this warning. An FDA Medication Guide should be distributed to patients starting a new prescription.
-adrenergic agonists may increase the risk of asthma-
Onset Duration > 24 h
≤ 30 min
, improves maximal work capacity and health-related
