Chronic obstructive pulmonary disease medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Philip Marcus, M.D., M.P.H. [2]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [3]

Overview

Treatment of COPD requires a careful and thorough evaluation by a physician. The most important aspect of treatment is avoiding tobacco smoke and removing other air pollutants from the patient’s home or workplace. Symptoms such as coughing or wheezing can be treated with medication. Respiratory infections should be treated with antibiotics, if appropriate. Patients who have low blood oxygen levels in their blood are often given supplemental oxygen.

Medical therapy

• Treatment of COPD requires a careful and thorough evaluation by a physician.
• The most important aspect of treatment is avoiding tobacco smoke and removing other air pollutants from the patient’s home or workplace.
• Patients who have low blood oxygen levels in their blood are often given supplemental oxygen.
• Oral and inhaled medications are used for patients with stable chronic obstructive pulmonary disease (COPD) to reduce dyspnea, improve exercise tolerance, and prevent complications.
• Symptoms such as coughing or wheezing can be treated with bronchodilators like subcutaneous medications, beta-adrenergics, methylxanthines, and anticholinergics. They act via decreasing muscle tone in small and large airways in the lungs.
• Respiratory infections should be treated with antibiotics, if appropriate.

General therapy

• Treatment of COPD requires a careful and thorough evaluation by a physician.
• The most important aspect of treatment is avoiding tobacco smoke and removing other air pollutants from the patient’s home or workplace.
• Patients who have low blood oxygen levels in their blood are often given supplemental oxygen.
• Oral and inhaled medications are used for patients with stable chronic obstructive pulmonary disease (COPD) to reduce dyspnea, improve exercise tolerance, and prevent complications. Symptoms such as coughing or wheezing can be treated with bronchodilators like subcutaneous medications, beta-adrenergics, methylxanthines, and anticholinergics. They act via decreasing muscle tone in small and large airways in the lungs.
• Respiratory infections should be treated with antibiotics, if appropriate.

Beta adrenergic receptor agonists

Short acting selective B2 agonist

• Used for symptomatic relief during acute mild, exacerbation
• Mechanism of action - Increases intracellular cyclic adenosine monophosphate via activation of B2 -adrenergic receptors on smooth muscle cells of airway and causes smooth muscle relaxation.
• These agents are less effective in COPD compared to Asthma.
• Drugs available are:

Albuterol, Metaproterenol, Pirbuterol

• Used for bronchospasm refractory to epinephrine.
• Route - Inhaled

Levalbuterol

• Albuterol is a racemic mixture containing both R and S enantiomer. The S enantiomer doesn't bind to Beta 2 receptor and maybe the cause of side-effects. On the other hand, levalbuterol has only active R enantiomer thus causes less side-effects.
• It is used for both treatment and prevention of bronchospasm.

Long acting beta-2 adrenergic receptor agonist

• The long acting beta 2 receptor agonist are used to alleviate chronic persistent symptoms
• They help to increase exercise tolerance, prevent nocturnal dyspnea, and improve quality of life.
• Long-acting beta-agonists include salmeterol, formoterol, arformoterol, and indacaterol.
• They all require twice-daily dosing, except for indacaterol. Bronchodilating effect lasts more than 12 hours. Indacaterol is administered once daily.

Salmeterol, Formoterol, Arformoterol

• Relieve bronchospasms.

• Facilitate expectoration, improve symptoms and morning peak flows.

• Used in addition to anticholinergic agents.

Arformoterol

• Higher potency than racemic formoterol.

Indacaterol

• Indacaterol a long-acting beta2-agonist (LABA) is used for long-term, once-daily maintenance in patients with chronic obstructive pulmonary disease (COPD).
• It is not for use as initial therapy in patients with acute deteriorating COPD.

Anticholinergics

Anticholinergic drugs act as a competitive inhibitor of acetylcholine and block their action on postganglionic muscarinic receptors, thus inhibiting cholinergically mediated bronchspasm and resulting in bronchodilatation.

• They block vagally mediated reflex arcs that cause bronchoconstriction.

• Reported adverse effects include dry mouth, metallic taste, and prostatic symptoms.

Ipratropium

• They have similar efficacy as beta 2 adrenergic receptor agonist.
• They have a synergistic effect on broncho-dilatation when combined with beta 2 agonist.
• They have a slower onset and longer duration of action. Thus, lesser helpful in use on an as-needed basis.
• Dose - 2-4 puffs at 6-8 hour duration.

Tiotropium

• It is the only long-acting muscarinic (once daily) anti-cholinergic agent available at this time
• It has become a first-line therapy in patients with persistent symptoms.
• It is more effective than salmeterol in preventing exacerbations.

External link

COPD CDC

References

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