Guidelines for COPD and Non pharmacological Interventions

Chronic obstructive pulmonary disease (COPD) is a leading cause of disability and death. Prevalence rates are related to tobacco smoking and indoor air pollution, and are expected to rise as smoking rates continue to increase among women and in developing countries. By 2030, COPD is expected to represent the third leading cause of death. Caring for patients with advanced disease who experience frequent exacerbations places a significant burden on health care resources. Evidence on the natural history of COPD demonstrates early institution of long acting bronchodilator therapy slows the rate of lung function decline and reduces frequency of exacerbations that can lead to further functional decline. The goals of therapy are symptom control, reduce exacerbations, and maintain quality of life. Smoking cessation, pharmacotherapy with long acting bronchodilators, inhaled corticosteroids, pulmonary rehabilitation, and palliative care are important components. This review highlights current guidelines and management strategies for COPD.

Advances in bronchoscopy--new and upcoming bronchoscopic methods at the dawn of the 21st century.

The last decade has seen the increasing application of bronchoscopic methods such as transbronchial needle aspiration in the staging of lung cancer as well as in the diagnosis of peripheral lung cancer, balloon dilatation using flexible bronchoscopy, development of new tracheobronchial stents to manage central airway obstruction, autofluorescence bronchoscopy for the early diagnosis of lung cancer and pediatric flexible bronchoscopy. There is also a better understanding in the mechanisms and management of hypoxemia during bronchoscopy such as upper airway obstruction. Recent developments include direct endobronchial ultrasound to increase the yield of transbronchial needle aspiration, high magnification bronchoscopy to assist in the diagnosis of early lung cancer and bronchoscopic lung volume reduction to gain the effects lung volume reduction surgery without the need for surgery in patients with severe emphysema. In this article the new and upcoming bronchoscopic techniques are discussed, which we believe will find a broader clinical application in the near future to manage patients in a better way.

Advances in bronchoscopy--therapeutic bronchoscopy.

The common indications for therapeutic bronchoscopy include relief of benign and malignant airway stenosis, in the intensive care unit, foreign body removal and management of hemoptysis. Debulking of airway tumors may be undertaken using techniques such as laser photoresection, electrocautery, cryotherapy, argon plasma coagulation or mechanically using rigid bronchoscopy. These techniques are often used in combination. Balloon dilatation and insertion of silicone or metallic airway stents can be undertaken to treat benign and malignant strictures or bronchomalacia. Airway stents maintain luminal patency by opposing extrinsic compressive forces or by providing internal support. Certain stent types may also physically prevent (Silicone and covered metallic stents) the encroachment of tumor tissue into the airways. Covered metallic airway stents are safe and effective in the management of malignant tracheoesophageal fistulae, reduce the risk of recurrent aspiration and provide enhanced quality of life by allowing resumption of oral nutrition. In this article, we present an overview of application and the current methods available to perform therapeutic bronchoscopy.