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A 62 year-old male patient was admitted to the hospital with severe chronic obstructive pulmonary disease (COPD). Pulmonary decompensation was precipitated by attack of .This slide compares a normal bronchus (left) with a bronchus from a patient with chronic bronchitis (right). Chronic bronchitis is defined clinically, but morphologically is characterized by hypertrophy and hyperplasia of submucosal glands. This change can be quantitated by the Reid Index, which is the ratio of the thickness of the submucosal glands divided by the bronchial wall thickness (measured from the inner perichondrium to the basement membrane). copyright 1999 KUMC Pathology and the University of Kansas, used with permission; courtesy of Dr. James Fishback, Department of Pathology, University of Kansas Medical Center.

Medical management included IV {a theophylline salt that causes bronchodilation}, oral prednisone (anti-inflammation), nebulized {a beta-2 selective that causes the bronchioles to }. The day following admission, the patient's pulmonary function worsens requiring the patient to be placed in intensive care.

Patients with COPD may respond favorably to another, non-adrenergic class of drugs. These drugs are muscarinic . A good example would be nebulized , quaternary agent with limited CNS effects. Since most inhaled drugs reach the systemic circulation, systemic side effects remain a concern. An ocular side effect, especially in elderly patients following administration of this class of agent is precipitation of .