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Chronic obstructive pulmonary disease: current comprehensive care for emphysema and bronchitis.

Chronic obstructive pulmonary disease (COPD) is the fifth leading cause of mortality in the United States. Most clients are initially seen when symptomatic and significant lung damage has already occurred; most cases are preventable. There is no cure for COPD, but lifestyle changes (especially smoking cessation) and proper treatment can significantly impact quality of life. The diagnostic tools most commonly used include chest x-ray, arterial blood gases, and pulmonary function tests. Pharmacologic interventions include steroids, bronchodilators, mucolytics, and an armamentarium of antibiotics, which must be selected with careful discretion. Because the prognosis of COPD may be guarded, the practitioner is obligated to provide information on advance directives. A sensitive approach, holistic perspective, consistent follow-up, and clinical astuteness are essential ingredients in the management of clients with COPD.