Strategies to improve breathlessness and exercise tolerance in chronic obstructive pulmonary disease

SummaryBreathlessness often limits patients with chronic obstructive pulmonary disease (COPD) in their activities. Many of the therapeutic interventions currently available relieve dyspnoea by addressing a combination of different mechanisms, namely (i) reduction of ventilatory demand, (ii) reduction of ventilatory impedance and (iii) improvement in ventilatory muscle function.Substantial improvements in dyspnoea, exercise tolerance and health related quality of life (HRQL) can be obtained as a result of programs of exercise training even in very severe patients. Several studies have shown that different modalities of ventilatory assistance during exercise reduce dyspnoea and work of breathing and enhance exercise tolerance in these patients.Another possibility is to reduce ventilatory demand by decreasing the central drive by opiates.As airway obstruction appears to predominate in the pathophysiology of dyspnoea in COPD patients, it is reasonable to try to alleviate these with bronchodilators, which are the mainstay of treatment in COPD.Lung volume resection surgery and lung transplantation in selected patients may control symptoms, improve HRQL, or extend survival.