The clinical management in extremely severe XXXX .

@entity1 @entity308 @entity26 @entity1576 @entity1286 @entity1030 @entity204
@entity1030 ( @entity1030 ) affects 6% of the general population and is the fourth-leading cause of @entity204 in the United States with severe and very severe disease accounting for 15% and 3% of physician diagnoses of @entity1030 . Guidelines make few recommendations regarding providing the provision of care for the most severe stages of disease, namely Global Initiative for @entity1030 (GOLD) stages III and IV with @entity1576 . The effectiveness of inhaled drug therapy in very severe @entity1 has not been assessed yet. Health care systems in many countries include public funding of long-term @entity26 therapy for eligible candidates. Currently, there is little evidence for the use of mechanical ventilatory support in the routine management of hypercapnic @entity1 . Pulmonary rehabilitation should be considered as a significant component of therapy, even in the most severe @entity1 . Although Lung Volume Reduction Surgery has been shown to improve mortality, exercise capacity, and quality of life in selected @entity1 , this modality is associated with significant morbidity and an early mortality rate in the most severe @entity1 . Despite significant progress over the past 25 years, both short- and long-term outcomes remain significantly inferior for lung transplantation relative to other "solid" organ recipients. Nutritional assessment and management is an important therapeutic option in @entity1 with chronic @entity1576 . @entity1286 may significantly reduce dyspnoea and does not significantly accelerate @entity204 . No consistent improvement in dyspnoea over placebo has been shown with anxiolytics. Supplemental @entity26 during exercise reduces exertional breathlessness and improves exercise tolerance of the hypoxaemic @entity1 . Non-invasive ventilation has been used as a palliative treatment to reduce dyspnoea. @entity1030 @entity1 , on long-term @entity26 therapy, may show reduced health-related quality of life, cognitive function, and @entity308 . Only a small proportion of @entity1 with severe @entity1030 discuss end-of-life issues with their physicians.
