Acute decompensation in chronic obstructive respiratory insufficiency. Pathogenesis of edema and role of noninvasive mechanical ventilation

: Chronic obstructive pulmonary disease (COPD) is rather common. It is nearly always associated with excessive smoking. In advanced stages of COPD, patients have severe obstruction of airways and develop often acute episodes of respiratory failure, commonly due to broncho-pulmonary infections. This review addresses nonpharmacological treatment of these episodes of acute decompensation. The value of mechanical ventilation is discussed in view of two recent advances: noninvasive ventilation by face or nose mask as alternative to tracheal intubation and improved notions about the pathogenesis of fluids and salt retention as causes of occasionally occurring edema.