Why use a bronchodilator in stable COPD?
Bronchodilator treatment provides symptomatic relief for patients with COPD. The main indication for the use of bronchodilator drugs is the relief of breathlessness or wheeze. For many patients with mild COPD, bronchodilator therapy (to be used as required) might be their only requirement.
Bronchodilator medication has no effect on prognosis in COPD . Therefore, there is no need to insist on regular medication. The patient can be advised to take their bronchodilator therapy as required. Patients with troublesome symptoms are likely to use a short-acting bronchodilator several times per day. Many such patients may benefit from the introduction of a long-acting b-agonist bronchodilator.
For patients with more advanced COPD, bronchodilator therapy should be used as an adjunct to other therapy such as oxygen (if hypoxic), pulmonary rehabilitation (if disabled by breathlessness) and smoking cessation (if still smoking).
It is important to emphasize that bronchodilators will have no benefit in an asymptomatic patient in whom COPD is identified at routine screening tests. Such patients should be given smoking cessation advice (if still smoking) but bronchodilator therapy should not be started until the patient becomes symptomatic.
The aim of bronchodilator treatment is to provide relief of symptoms and, if possible, to extend exercise tolerance. Long-acting bronchodilators may reduce exacerbation rates in COPD as discussed below. For some patients with COPD, bronchodilator therapy may facilitate mucus expectoration. For a minority of patients with advanced COPD and problems with mucus clearance, this might best be achieved with nebulized bronchodilator therapy or with the use of nebulized saline as an adjunct to bronchodilator therapy from a metered dose inhaler.
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Among the evils which a vitiated appetite has fastened upon mankind, those that arise from the use of Tobacco hold a prominent place, and call loudly for reform. We pity the poor Chinese, who stupifies body and mind with opium, and the wretched Hindoo, who is under a similar slavery to his favorite plant, the Betel but we present the humiliating spectacle of an enlightened and christian nation, wasting annually more than twenty-five millions of dollars, and destroying the health and the lives of thousands, by a practice not at all less degrading than that of the Chinese or Hindoo.