The overall goal in the manage-ment of patients with advanced lung disease is to improve the quality of life. Multicenter studies have demonstrated increase in survival in COPD patients with hypoxemia after long-term oxygen therapy. Survival is greatest if the patient uses the oxygen on a continuous basis. Pulmonary rehabilitation is increasingly being recognized as an important part of the comprehensive management of these patients. However, pulmonary rehabilitation does not improve conventional pulmonary function test scores.
Pulmonary rehabilitation uses a multi-disciplinary approach.
Pulmonary cachexia is associated with early mortality. Weight gain in these patients leads to improvement in their respiratory muscle strength. When the disease process is so advanced that the patient cannot maintain an adequate alveolar ventilation, mechanical ventilation with ventilator support is required. Lung transplantation is now considered a very viable therapeutic modality for a variety of selected patients. Single lung transplant is most common.