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Chronic obstructive pulmonary disease (COPD) is treated with bronchodilator and antiinflammatory drugs along with smoking cessation and pulmonary rehabilitation. The pharmacological treatment of COPD is based on the assessment of current symptoms and future risk as first proposed in the GOLD 2011 strategy document. Long-acting bronchodilatators are the cornerstone of treatment of COPD and inhaled drugs are always preferred. Inhaled corticosteroids can be added for reducing exacerbations where also roflumilast has proven efficacy. This review covers recommendations for treating COPD according to the latest recommendations from the Danish Respiratory Society.

Macrolides have been proposed to have a positive effect in patients with inflammatory lung diseases, including patients with chronic obstructive pulmonary disease (COPD), who suffer from acute exacerbations. Increased use of macrolides for long-term treatment of patients with COPD has been observed. The evidence of a treatment effect of macrolides in this area is sparse, but some studies suggest that it might be beneficial on the number of exacerbations and the length between them. At present there is not sufficient evidence to issue a general recommendation for prescribing macrolides for the long-term treatment of COPD.

Patients with chronic obstructive pulmonary disease have a high risk of osteoporosis and fractures. We present an algorithm for the prevention and treatment of osteoporosis in patients with chronic obstructive pulmonary disease.

A Cochrane review of telehealthcare in chronic obstructive pulmonary disease (COPD) has found telehealthcare to have a positive effect on quality of life in patients with COPD and reduced health-care contacts. In this comment, the fact that the reviewed studies all contain interventions in which telehealthcare is only one part is highlighted. No studies comparing complex interventions with and without telehealthcare exist in COPD and more studies are therefore clearly needed before further implementation of this technology.

Chronic obstructive pulmonary disease (COPD) is characterised by airflow limitation and is associated with an inflammatory response of the lungs primarily caused by cigarette smoking. Cigarette smoking is by far the most important environmental risk factor for COPD, but less than half of all heavy smokers develop COPD. This indicates a genetic contribution to the individual disease susceptibility. Although many genes have been examined, the puzzle of COPD genetics seems still largely unsolved. It is therefore important to measure phenotypes and to perform genome-wide scans of COPD patients in order to unravel the contribution of the COPD susceptibility genes.

COPD is one of the leading causes of death worldwide. No recent prevalence study has been carried out in Denmark, but it is estimated that approximately 200,000 Danes have COPD. The aim of this study was to determine the prevalence of COPD in Copenhagen using data from the 4th examination of The Copenhagen City Heart Study (CCHS from 2001-2004) and to estimate the total number of COPD patients in Denmark.6,238 people participated in the 4th examination of CCHS. We selected all participants aged 35 years or older with adequate information regarding smoking habits and lung function for the final prevalence analyses (n = 4,908). COPD staging was done according to the GOLD and ERS/ATS criteria. We received information regarding the Danish population from The National Bureau of Statistics Denmark.The prevalence of COPD in the 4th CCHS increased with age and was higher among males than females. The total number of Danes with COPD is estimated to 430,000, 270,000 of whom have clinically important COPD (GOLD 2-4) and 40,000 have severe COPD (GOLD 3-4).The prevalence of COPD in Denmark is higher than previously anticipated. The 40,000 patients with severe COPD are in immediate need of relevant medical treatment and rehabilitation. Danish society also needs to exert a substantial effort comprising early detection, prophylaxis and relevant treatment for the 230,000 persons with moderate COPD in order to prevent disease progression.

In this study 6,112 COPD patients were treated with salmeterol 50 microg bid, fluticason 500 microg bid, salmeterol/fluticason combination 50/500 microg bid (SFK) or placebo for 3 years. The primary effect parameter was mortality and 875 patients had died after 3 years. Hazard ratio for death for SFK compared with placebo was 0.825, 95% confidence interval 0.681-1.002, p=0.052, or an absolute risk reduction of 2.6%. Active treatment reduced exacerbations and improved quality of life and lung function. The risk of pneumonia was higher in the fluticason and SFK treated groups than in the placebo group.

The aim of this study was to describe the prognosis after hospitalization after exacerbation of chronic obstructive pulmonary disease (COPD).A retrospective study of 300 consecutively admitted patients with exacerbation of COPD in three departments of internal medicine with special interest in respiratory medicine. Data were collected from patient charts.The mean age was 71.3 years. 59.7% were women and 60.9% had cor pulmonale. In 44% of the patients hypoxia was documented at the time of admission. Twentysix(9%) patients died during hospitalization. After three and 12 months mortality was 19% and 36%, respectively. Age, cor pulmonale and hypoxia at the time of admission were associated with increased mortality, whereas impaired lung function, long term oxygen treatment, and a record of hospitalization with the same diagnosis in the previous 30 days were associated with increased mortality in univariate analysis, but not when adjusted for age, gender, and hypoxia at admission. The risk of readmission was increased in cor pulmonale, while cessation of smoking during hospitalization reduced this risk.Patients who have been hospitalized with exacerbation of COPD has a high mortality and a high risk of readmission.

Chronic obstructive pulmonary disease (COPD) is a leading cause of hospitalisation in Danish adults, and admission rates are expected to increase in the future. Assisted home care with disease monitoring and treatment by a pulmonary nurse may reduce time spent at hospital and the economic burden of COPD. In order to evaluate various types of assisted home care, the selection of patients, feasibility, effect, safety, and cost-effectiveness, the literature was reviewed. Most information is available on assisted home care following a hospital-based assessment and led by a respiratory nurse. According to the literature, assisted home care is a well tolerated, safe, and economic alternative to hospital admission for about 25-30% of the patients referred to hospital due to exacerbation of COPD. We recommend that assisted home care is tested in Denmark.

We wanted to examine the factors that were of importance for the hospital outpatient treatment of teenagers with asthma.A total of 89 teenagers received a postal questionnaire and an invitation to participate in a focus group interview on outpatient asthma follow-up.Only 16 answered the questionnaire and 7 participated in the interview. The importance of personal contact was stressed and the teenagers expected much from the personnel aiming to help them. In a questionnaire follow-up of initial non-responders, 82% still had asthma and 75% of these received asthma medication.The low participation rate and the high expectations explain why teenagers with asthma constitute a group of patients with less than optimal results of treatment.

Chronic obstructive pulmonary disease (COPD) is characterised by progressive diminution of pulmonary function with minimal reversibility. The initially organ-related symptoms gradually involve secondary organs and end-stage COPD can be considered a systemic disease. The most important cause of COPD is tobacco smoking. In recent years there has been increasing focus on the pathophysiological events leading to COPD, and oxidative stress has been suggested as one of the major pathophysiological factors. Clinical studies indicate a causal association between tobacco smoking, oxidative stress, increased inflammatory response, and destruction of lung parenchyma. This article reviews the clinical literature on oxidative stress as a pre-inflammatory state, leading to COPD in susceptible smokers.

Lower respiratory tract infections are common in the community. It might be difficult to differentiate between acute bronchitis, exacerbation of chronic obstructive pulmonary disease, and pneumonia. There is no satisfactory way of defining pneumonia by clinical criteria alone. Measurement of C-reactive protein is useful, but the specificity of the test is low, and must be carefully evaluated in comparison with the duration of illness and the clinical picture. The antibiotic management of lower respiratory tract infections must suppress Streptococcus pneumoniae. We therefore recommend that the first drug of choice should be penicillin V.