Antibiotics No Help for Most Emphysema, Chronic Bronchitis
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Jan V. Hirschmann, MD, is professor of medicine at the University of Washington in Seattle and assistant chief of medicine at Seattle's Veterans Administration Medical Center. He did not help write the guidelines, but his research helped show that antibiotics don't help COPD patients.
The guidelines also would cut down on the amount of steroids a patient is given. Steroids commonly are given to people with COPD to improve the function of their lungs. The guidelines find no use at all for inhaled steroids and suggest that steroids taken orally or by injection should be taken for no more than two weeks. Steroids have a wide range of unwanted side effects -- and many doctors have routinely prescribed much longer courses of steroid treatment for their COPD patients.
Another change is in the use of bronchodilator inhalers.
"We doctors tend to hit these patients from all sides -- usually we give them two kinds of inhalers, a beta2 agonist [such as Proventil or Ventolin] and an anticholinergic [such as Atrovent]," Snow says. "Now we say start with the anticholinergics and then add beta2 agonists if more relief is needed."
The guidelines also advise against a category of bronchodilators known as methylxanthines, which already have been falling out of favor because of their high risk of dangerous side effects. And they say that mucus-dissolving drugs are no help at all.
So what can doctors do for hospitalized patients having severe COPD exacerbations? The guidelines recommend giving a short course of steroids as well as oxygen-enriched air through a mask that helps push air into the lungs.
This doesn't sound like much -- and the guidelines face this fact by calling for much more in-depth research into new treatments and better ways to take care of these severely ill patients.
Meanwhile, Snow has some advice for people who are still healthy: "The biggest message these guidelines have is that people should stop smoking."