Chronic obstructive airways disease.

1. Chronic obstructive airways disease is a term which should be reserved for those who have objective evidence of airways obstruction and who do not improve significantly with bronchodilators or steroids. All patients should have a trial of aggressive treatment with these drugs in case they have chronic asthma. 2. All patients should be urged strongly to give up smoking. 3. There is no scientific evidence that slow release aminophylline or theophylline are of benefit in these patients, and they may be hazardous in those with coronary artery disease. 4. Acute infective exacerbations may be due to haemophilus influenzae or pneumococcus; patients with fever should be given co-trimoxazole, ampicillin, co-amoxiclav or erythromycin (co-trimoxazole should generally be avoided in the elderly). 5. Domiciliary oxygen therapy, given for at least 12 and preferably 16 hours a day, will prolong survival in patients with Type II respiratory failure ('blue bloaters'). It may help symptoms in Type I respiratory failure ('pink puffers'). It should only be prescribed after blood gas measurements and the patient must therefore be referred.