[RETRACTION AND SINCERE APOLOGY]
I believe Alessandra is right!
Thinning and *mobilization* of secretions: Viscid secretion in peripheral airways is an important mechanism of airway obstruction in COPD. No drugs, whether administered orally or by inhalation, effectively thin secretions. Dehydration thickens secretions, so patients should maintain good hydration. Advising patients to drink enough fluid to keep the urine pale, except for the first morning voiding, is reasonable. Inhaling steam from hot water in the bathroom sink may help some patients expectorate secretions. Controlled coughing, consisting of two or three coughs in succession after a deep inhalation, helps mobilize sputum. Chest wall percussion with cupped hands or an electromechanical percussor may also help mobilize sputum in difficult cases. However, its efficacy has not been proved in COPD.
Secondary therapy: Improving the function of the whole person is the goal of this therapy; it has little effect on the underlying lung disease. The patient should be encouraged to accept responsibility for complying with the treatment regimen.
Oxygen therapy: Long-term O2 therapy prolongs life in hypoxemic COPD patients. A 24-hr regimen is better than a 12-hr nocturnal regimen. This therapy reduces the hematocrit toward normal levels, moderately improves neuropsychologic factors, and ameliorates pulmonary hemodynamic abnormalities. Pulmonary O2 toxicity is not a problem, and increases in PaCO2 are minimal in patients with hypercapnia.
At hospital discharge, long-term O2 therapy should be prescribed for all patients who meet the criteria (Table 68-9)--eg, those who desaturate during low-level exercise to a PaCO2 <= 55 mm Hg (SaO2 <= 88%). After 30 days, room-air PaO2 should be reassessed to determine if they still meet the criteria.
A sleep study should be considered for patients with advanced COPD who do not meet the criteria for long-term O2 therapy but whose clinical assessment suggests the adverse effects of hypoxemia. Nocturnal O2 may be prescribed ....
So, I was wrong...but happy to confirm the validity of Alessandra's reply!
We are all here to learn!