Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease. 1 It is among the fastest growing chronic diseases diagnosed in the world today. COPD is the third most common cause of death in the United States 2 and is predicted to get worse. It is characterized by the development of an exaggerated inflammatory response of the lungs to noxious substances such as tobacco or air pollution. If the exposure becomes recurrent or persistent, the lungs develop chronic inflammatory response leading to lung parenchymal damage, air trapping and progressive airflow limitation. The Diagnosis of COPD is usually made in the contest of symptoms, exposure to risk factors and spirometry evidence of airway obstruction with post bronchodilator spirometry FEV1/FVC < 0.70. Most patients with COPD first sick medical attention when they develop dyspnea. 1 Once the diagnosis of COPD has been confirmed, the treatment is geared mainly towards preventing exacerbations and eliminating risk factors and exposures. Several treatments combinations can be used in patients with stable COPD to prevent exacerbations and to improve their quality of life. Patients with COPD exacerbations have to be appropriately diagnosed and promptly treated to prevent complications. Patient's symptoms, the degree of airflow limitation, risk of exacerbations and the presence of comorbidities have to be assessed. Both pharmacological and non-pharmacological interventions have been used in the management of COPD.

Over the years, the management of chronic obstructive pulmonary disease has evolved, but given the high mortality and morbidity of COPD, much work still needs to be done. To date, none of the existing pharmacological therapies for COPD has been shown conclusively to modify the longterm decline in lung function. Several trials have been completed to evaluate options that can improve patient symptoms and quality of life. Optimal management for patients with COPD requires both pharmacological and nonpharmacological managements. Some of the non-pharmacological options for the management of COPD like Oxygen therapy have proven reduction in mortality and mortality, and an improvement in the quality of life. Lung transplant is the only treatment that can stop the decline in lung function. Smoking cessation is the non-pharmacological intervention with the greatest capacity to influence the natural course of COPD. Pulmonary rehabilitation programs are evidence based, multidisciplinary and comprehensive interventions for patients with COPD. These programs involve patient assessment, exercise training, education, nutrition and psychosocial support. Pulmonary rehabilitation programs are designed to reduce symptoms, optimize functional status, increase participation and reduce health care cost through stabilizing or reversing systemic manifestations of the disease. This article discusses the most used non pharmacological management of COPD and their usefulness in relieving symptoms and improving the quality of life for patients with severe COPD. These treatment options are used in addition to optimal pharmacological therapy.

Chronic Obstructive Pulmonary Disease (COPD) is a disease which warrants a great attention due to the mortality and morbidity caused by COPD. Once a patient has been diagnosed with COPD, a clear plan of care has to be established. Pharmacological management is usually the initial treatment in addition to prevention. COPD exacerbations impair the patient's quality of life and decrease their health status. The decision to start treatment in patient with COPD should be based on the number of symptoms and the risk for exacerbations. Exacerbations will eventually occur in most patients with COPD. The prevention of exacerbations is one of the main goals in the management of COPD. Early recognition and prompt treatment of COPD exacerbation, is very beneficial to the overall outcome of the patient. Stable COPD has several treatment options available based on the stages and so patients within the same stage may be on different treatment regimens. The management of COPD is stepwise. The aim of pharmacological management of COPD is to decrease symptoms and complications. For patients with stable COPD, the treatment goals are to reduce the risk of exacerbation, decrease symptoms and improve exercise tolerance aiming at improving general health and quality of life. This article details the pharmacological management of COPD.

Medical and non-pharmacological treatments continue to be the initial managements for chronic obstructive pulmonary disease (COPD). These managements have evolved over time, but given the high mortality and morbidity of COPD, much work still needs to be done. To date, none of the existing pharmacological therapies for COPD has been shown conclusively to modify the long-term decline in lung function. Several trials have been completed to evaluate options that can improve patient symptoms and quality of life. Optimal management for patients with COPD requires both pharmacologic and non-pharmacologic managements. To date, the only treatments that can modify the course of COPD and potentially cure the disease are surgical treatments. Some of the surgical managements we discussed in this review include Lung Volume Reduction Surgeries (LVRS), Bronchoscopic Volume Reduction Surgery (BVRS), bullectomy and lung transplants. The indications for these surgical managements have also been discussed in this article. Patients for surgical managements have to be appropriately selected to avoid some of the major adverse events that can occur because of some of the treatment modality.