Outpatient management of chronic bronchitis and emphysema.

Proper treatment relieves the symptoms of chronic bronchitis and emphysema to a large extent and helps patients remain active and useful until the last stages of the disease. Not much can be done to halt the natural course, since the disease is well advanced by the time that symptoms appear. Respiratory infections pose a constant threat. They are the primary cause of increased morbidity and mortality in these patients and may well accelerate the disease process. Annual prophylaxis against influenza is recommended, and antibiotic suppression should be considered for patients who have repeated bouts of acute bronchitis. Airways obstruction in emphysema is irreversible, but oral bronchodilators may remedy bronchospasm in chronic bronchitis and in emphysema with a bronchitic component. If sputum is thick and tenacious, postural drainage and chest physiotherapy may be helpful. Corticosteroids should be used only as a last resort. Patients tend to become inactive as the disease progresses. Exercise is important to increase exercise tolerance and overall physical fitness, and the physician should prescribe a specific daily program within the patient's limitations.