Chronic obstructive pulmonary disease (COPD) is a debilitating pulmonary disorder with systemic effects, and it is the fourth leading cause of death in the United States. COPD patients not only develop respiratory limitations, but can also demonstrate systemic wasting, features of depression, and can succumb to social isolation. Smoking cessation is crucial, and pharmacotherapy with bronchodilators is helpful in symptom management. Inhaled corticosteroids may be beneficial in some patients. In addition, pulmonary rehabilitation and palliative care are important components under the right clinical circumstance. This review highlights current guidelines and management strategies for COPD and emphasizes novel pharmacotherapy and minimally invasive (nonsurgical) lung-volume reduction interventions that may prove to be of significant benefit in the future. 1. Epidemiology Chronic obstructive pulmonary disease (COPD) is a syndrome characterized by chronic and progressive airflow reduction that is scarcely reversible and by inflammation of the small airways. It is the potential functional consequence of two diseases that can often coexist in the same patient, such as panlobular emphysema and fibrosing chronic bronchiolitis with or without significant centrilobular emphysema. It can also include chronic bronchitis (the presence of a chronic productive cough for 3 months or more in each of 2 consecutive years) [1, 2]. Chronic bronchitis per se is a smoking related disease of large airways that often resolves after smoking cessation. Nevertheless, patients with COPD who suffer from chronic bronchitis generally show faster functional decline, more exacerbations, and greater morbidity and mortality. Furthermore, a greater percentage of subjects with chronic cough and phlegm who continue to smoke can have COPD as compared with smokers without symptoms when functionally reassessed after 8 years [3]. However, the majority of patients with chronic bronchitis will not suffer from COPD [2, 3]. Therefore, chronic bronchitis itself can be considered as both a risk factor for COPD, and a worse prognostic factor in the presence of COPD. COPD typically progresses over time and is associated with an increased inflammatory response of the lung to continued environmental exposures which is often tobacco smoke [4]. The natural history of COPD is punctuated by breathlessness especially on exertion with daily activities of normal living, increased production and purulence of sputum, overall health decline, and episodes of exacerbations that require medical attention and
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