THE MANAGEMENT OF RESPIRATORY FAILURE IN CHRONIC OBSTRUCTIVE LUNG DISEASE.

Abstract

SummaryThe management of the chronic respiratory diseases should consist of measures designed to restore as far as possible normal pulmonary function. It must be emphasized that patients with chronic respiratory disease, like patients with diabetes or heart failure, are suffering from a chronic condition which may be incurable, but progression of the disease can be prevented to a large extent. For this reason, the patients should be advised to continue all modes of therapy and to inhale the nebulized bronchodilator in a proper fashion every day, as soon as they wake up in the morning, the last thing at night before going to bed, at any time during the day or night they might feel the slightest tightness in the chest, and prior to undertaking any exertion. The morning and night therapy, maintenance of adequate hydration, and oral bronchodilators should be continued no matter how well they feel. The importance of preventative measures cannot be stressed enough in the managment of respiratory disease. Too often the patient is sent home from hospital without being advised to continue his medications in order to prevent attacks of bronchial obstruction.When respiratory failure with hypoxia and hypercapnia develops, therapy should be directed at improving the alveolar ventilation by reduction of work of breathing through alleviation of airway obstruction and pulmonary congestion; and reducing the metabolism by treating infection or excessive weight; and provision of an adequate alveolar ventilation by assisting or controlling ventilation.Because of our advances in knowledge of therapy of this condition, we are now being faced with patients who, despite continuation of these measures in an intensive fashion, reach a state where no improvement in clinical status and arterial blood gases can be achieved. These patients pose a great therapeutic challenge, and much can be done to prevent progression of the disease. In our hands we have observed extremely beneficial results from the use of Dichlorphenamide, a graded exercise program, and the establishment of a “Home Care” program.