Management of Chronic Respiratory Diseases

Chronic respiratory diseases such as asthma and chronic obstructive pulmonary disease (COPD) are common throughout the world and cause a great deal of morbidity and mortality. Acute exacerbations can result in missed work, hospitalizations, and sometimes death. This review will discuss the epidemiology, pathophysiology, and risk factors for developing these diseases. Patients with significant smoking history (40 pack-years or more) have the most risk for COPD. Diagnostic methods involve careful history taking from patients and spirometry/pulmonary function testing. Evaluation methods to gauge severity for both diseases will be discussed as they are essential to providing effective treatments. Pharmacological treatments include inhaled bronchodilators, corticosteroids, and muscarinic antagonists. For asthma, there are recently developed biologic agents that target specific inflammatory pathways which can be utilized in severe or intractable cases. Non-pharmacological interventions such as smoking cessation, environmental controls, vaccinations, pulmonary rehabilitation, team-based care, and osteopathic manipulation will also be discussed.