Oxygen and Ventilatory Therapy and Lung Transplantation of the Chronic Obstructive Pulmonary Disease (COPD)

Jung, Tae Hoon

Abstract

Chronic obstructive pulmonary disease (COPD) is a disease state characterized by airflow limitation, and in advanced COPD, peripheral airway obstruction, and pulmonary vascular abnormalities reduce the lung's capacity for gas exchange, producing hypoxemia and, later, hypercapnia. Oxygen therapy, one of the principal non-phamacologic treatments for patients with advanced COPD, can be administered in various ways. Long-term oxygen therapy improves longevity in patients with COPD who are chronically hypoxemic; it may also decrease morbidity, decrease disability, and improve handicap in some patients. A prescription for long-term oxygen therapy should outline the dose of oxygen for rest, sleep, activity, and exercise; the duration of continuous use; and the delivery devices required. Ventilatory support can be applied both invasively and noninvasively in patients with an acute exacerbation of COPD, as well as in stable COPD patients. Noninvasive ventilatory support is attractive therapy and should be tried whenever possible. Positive pressure ventilation is the mode of choice for ventilatory support, both in patients with acute exacerbation of COPD and in stable patients. In the acute situation, the main goals of ventilatory support are to reduce the work of breathing and to support gas exchange and alveolar ventilation. In appropriately selected patients with COPD, lung transplantation prolong life, improves functional capacity, and enhances the quality of life. The choice of transplantation procedure is determined on an individual basis by predetermined guidelines and experience of the individual transplantation center. However, rejection remains an obstacle to better mid-term results, and its effects on survival remain controversial.