Chronic obstructive pulmonary disease (COPD) has historically been felt to be fairly unresponsive to pharmacologic therapy because of the poor improvement in lung function. Newer data on inhaled steroids and long-acting broncho-dilators lend support that these agents may improve exacerbation rates and health status. International guidelines reflect these data by recommending long-acting bronchodilators at moderate levels of severity, and inhaled steroids in those with severe COPD or frequent exacerbations. Immunization with influenza and pneumococcal vaccines are important preventive strategies. However, the one treatment that yields the best results but is possibly the most difficult to implement successfully is smoking cessation. Elderly individuals provide challenges, but opportunities exist for symptom and quality of life improvements with appropriate pharmacologic intervention. (Annals of Long-Term Care: Clinical Care and Aging 2006;14[12]:27-35)

The nursing home medical director is now under new scrutiny by regulators. The new surveyor guidelines for “Tag F501, Medical Director” released by the Centers for Medicare & Medicaid Services were implemented in November 2005. They teach surveyors how to scrutinize the adequacy of medical director performance and link deficiencies in performance to poor outcomes of care. In the past, many medical directors held the position in title only with minimal pay, but the change in regulatory framework raises the standard for the nursing home industry. The medical director must now provide active clinical guidance and oversight regarding implementation of policies, collaborate with administration and staff to promote quality of care, and take an active part in resolving medical and clinical concerns that affect resident care. (Annals of Long-Term Care: Clinical Care and Aging 2006;14[12]:36-40)