Smoking cessation, immunization against influenza and pneumonia, and pulmonary rehabilitation have been shown to improve function and reduce subsequent COPD exacerbations. 6 , 7 , 30 Long-term oxygen therapy decreases the risk of hospitalization and shortens hospital stays in severely ill patients with COPD. 7 , 31 , 32 The indications for long-acting inhaled bronchodilators and inhaled corticosteroids to improve symptoms and reduce the risk of exacerbations in patients with stable COPD are reviewed elsewhere. 5 , 7 , 33 – 38
Doctors use a combination of assessments that evaluate a patient’s airflow obstruction and symptoms (breathlessness, persistent cough, mucus production etc.) to guide treatment selection. A group of the world’s leading COPD experts form an advocacy group called The Global Initiative for Chronic Obstructive Lung Disease (GOLD). They have published guidelines for assessment of disease severity and appropriate treatment sometimes called the GOLD COPD stages. One GOLD assessment test categorizes patients based on the extent of airflow limitation using spirometry (breath) testing (GOLD grade 1-4). Another categorizes patients based on their symptoms and risk of exacerbation (GOLD group A-D). Recommendations for treatment are based on the GOLD group A-D score.