In the following sections, various pharmacologic therapies for COPD and the clinical evidence for each therapy are reviewed. Pharmacotherapy is generally added in a stepwise fashion, depending upon the level of symptoms, risk of exacerbations, and response to therapy ( table 1 ). However, for patients who present with more severe disease, a stepwise approach may not always be the best choice, as it may be necessary to initiate several medications at once to achieve appropriate symptom and exacerbation control. An approach to the management of patients with stable COPD is outlined below. (See 'Summary and recommendations' below.)
Hi, I just bought your book, and I’m very excited to get started. I’ve always wanted to be in “good shape,” lean and tone, but have never been able to get rid of jiggle. I’m curvy at 5’3″ and 132 pounds, and getting rid of fat in place of muscle is what I’m looking to do. I’ve always tried to remain active, even when I can’t go to the gym on a regular basis. For the past few weeks I’ve been working out twice a day, with heavy cardio and mild weight training in the morning, and interval circuit training in the evening while also doing a heavy HEAVY cut back on calories. I lost weight in my first week, but after that, it kind of just stuck near 132 and hovered. I’m much more concerned with my appearance than the number on the scale (though that doesn’t hurt either). I’m a little nervous that going from eating so few calories to what you recommend might cause a temporary fat gain. Also, I have a very busy schedule, but I make the time to make my own lunches and snacks to bring to work so that I can stay on track with whatever program I’m doing. Is there a meal plan provided in the book or just guidance tips to create your own? The book comes tomorrow, but I’m excited to get started and want to make sure I have all the tools I need to do so.