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Pharmacotherapy Of
COPD
Presented By
Ms. Pranali A. Chandurkar
Assistant Professor
Department of Pharmacology
Dr. Rajendra Gode Institute of Pharmacy, Amravati.
Chronic Obstructive Pulmonary Disease
(COPD)
• Also called as Chronic Obstructive Airway Disease.
• COPD is characterized by difficulty in exhaling air.
• It is slowly progressive disease and irreversible.
• The most common cause of COPD is Cigarette Smoking.
• COPD may include diseases that cause airflow obstruction (eg.,
Emphysema, Chronic Bronchitis) or combination of these disorders.
1)Chronic Bronchitis
• Chronic bronchitis is a chronic inflammation of the lower respiratory tract
characterised by excessive mucous secretion, cough & dyspnea associated with
recurrent infection of the lower respiratory tract.
• The condition is more common in middle-aged males than females i.e.,
approximately 20% adult men and 5% adult women.
Risk Factors :
• Smoking
• Air pollution (Dust, NO2, SO2, toxic fumes etc)
• Genetic factor
COPD.pptx
Pathophysiology
Sign And Symptoms
• Cough
• Wheezing
• Shortness of breath
• Chest tightness
• Hypoxemia
• Hypercapnia
• Cyanosis
Emphysema (Pink Puffers)
• Emphysema is a form of chronic lung disease which is characterised by the
irreversible enlargement of air spaces.
• The most common cause is tobacco smoking and congenital α1AT deficiency.
• Types :
1) Centriacinar emphysema
2) Pacinar emphysema
3) Paraseptal (Distal acinar) emphysema
4) Irregular emphysema
Pathophysiology
Sign And Symptoms
• Weight loss
• Dyspnoea
• Cough occur late after dyspnoea start
• Wheezing
• Cough
• Shortness of breath
• Long term mucus production
• Enlarged chest
Pharmacotherapy
1) Risk Management :
• Smoking cessation is the single most effective intervention to prevent COPD
or slow its progression.
• It is major essential to reduce disease
• progression and improve survival rate.
• Use nicotine replacement product and
• medication to quit smoking.
2) Bronchodilators :
• Bronchodilators relieve bronchospasm and reduce airway obstruction by allowing
increased oxygen distribution throughout the lungs and improving alveolar
ventilation.
• They are mostly used for the management of COPD, which are delivered through a
metered-dose inhaler (MDI) by nebulization or via oral route.
• Both short acting and long acting bronchodilators are used.
a) Short-acting Bronchodilators : Salbutamol
Ipratropium
b) Long-acting Bronchodilators : Tiotropium
Salmeterol
Formoterol
a) Short-acting bronchodilator inhalers
• For most people with COPD, short-acting bronchodilator inhalers are the first treatment used.
• Bronchodilators are medicines that make breathing easier by relaxing and widening your airways.
• There are 2 types of short-acting bronchodilator inhaler:
1) β2 agonist inhalers : Salbutamol and Terbutaline
2) Antimuscarinic inhalers : Ipratropium
• Short-acting inhalers should be used when you feel breathless, up to a maximum of 4 times a day.
Salbutamol
• It is highly selective B2 agonist
• Produces bronchodilation within 5 min by relaxing the bronchiolar smooth muscle.
• Action last for 2-4 hrs.
• Side effects : Muscle tremor, Palpitation, Restlessness, Nervousness, Throat irritation, Ankle edema
• Dose : 100-200 ug by inhalation
Ipratropium bromide
• It is a short acting inhaled anticholinergic bronchodilator.
• It blocks the bronchoconstriction mainly in the larger airways.
• Action last for 4-6 hrs
• Inhaled anticholinergics are the bronchodilator of choice in COPD.
Combination of Salbutamol and Ipratropium
• DUOLIN INHALER : 100 ug + 20 ug per metered dose
• DUOLIN ROTACAP : 200 ug + 40 ug per rotacap
• DUOLIN RESPULES : 2.5 mg + 500ug in 2.5 ml solution
Long-acting bronchodilator inhalers
• If you experience symptoms regularly throughout the day, a long-acting bronchodilator inhaler will
be recommended.
• These work in a similar way to short-acting bronchodilators, but each dose lasts for at least 12 hours,
so they only need to be used once or twice a day.
• There are 2 types of long-acting bronchodilator inhaler:
a. β2 agonist inhalers : Salmeterol, Formoterol and Indacaterol
b. Antimuscarinic inhalers : Tiotropium, Glycopyronium and Aclidinium
Salmeterol
• It is the first long acting selective B2 agonist with slow onset of action.
• Long acting B2 agonist are superior to short acting ones and equivalent to inhaled anticholinergic in
COPD.
• They reduces breathlessness by preventing expiratory closure of peripheral airways and abolishing
the reversible components of airway obstruction.
• Dose : Salmeterol 25 ug per metered dose inhaler; 2 puffs BD; severe cases 4 puffs BD
Formoterol
• It is a long-acting selective B2 agonist
• Action last for 12 hrs
• In comparison to Salmeterol, it has faster onset of action
• Dose : 12-24 ug by inhalation twice daily.
Tiotropium Bromide
• It is a long acting inhaled anticholinergic bronchodilator.
• Action last for 24 hrs.
• Tiotropium is more effective than ipratropium in COPD.
• Regular maintenance therapy with long acting anticholinergic
inhalationcan reduces the episode of COPD exacerbations.
New Drugs :
• Indacaterol, Olodaterol, Vilanterol are new ultra long acting selective B2
agonist that have been approved for maintenance treatment of COPD.
• They are administered by inhalation in powder form ( Indacaterol, Vilanterol)
or solution form (Olodaterol) once a day.
• Side effects: Cough
Dizziness
Nasopharyngitis.
• Glycopyrronium Bromide is a long acting anticholinergic drug has been
approved as a maintenance treatment of COPD.
• Dose : 50ug inhalation powder per cap once a day.
3) Methylxanthines :
• Theophylline, Aminophylline
• It decreases release of histamine, other mediators and cytokines from mast cells and
activated inflammatory cells.
• Adverse effects : Theophylline has a narrow margin of safety.
• Headache, nervousness, nausea, dyspepsia, insomnia, convulsions, delirium,shock,
arrhythmias
• Dose : Theophylline 100-300 mg TDS
Aminophylline 100 mg tab, 250 mg/ 10 ml inj.
• Theophylline used in the treatment of chronic COPD improve lung function like
vital capacity and FEV1.
• Theophylline used in patients who are intolerant to inhaled bronchodilators.
• If patients does not achieve optimum clinical response with β2 agonist and
anticholinergic then methylxyanthines are added to the regimen.
Roflumilast
• It has been approved by US-FDA for symptomatic treatment of COPD.
• It is a selective PDE4 inhibitors.
• It exerts antiinflammatory action, primarily in the lungs.
• Lung function is improved and risk of exacerbations is reduced.
• Adverse effects : Diarrhoea
weight loss
psychiatric disturbances
4) Corticostroids :
• Glucocorticoids are not broncodilators.
• They benefit by inhibiting inflammatory cytokine production and eosinophilic,
lymphocytic infiltration of lungs.
• They also reduce bronchial hyperreactivity, mucosal edema and suppress inflammatory
response to AG:AB reaction or to other stimuli.
a) Inhaled steroids :
• Fluticasone, Budesonide
• It reduces airway inflammation and help to prevent exacerbations.
Fluticasone :
• Fluticasone propionate is an inhaled glucocorticoid which has high potency, longer
duration of action and negligible oral bioavailability.
• The dose swallowed after inhalation has little propensity to produce systemic effects.
• At high doses, systemic effects may be due to absorption from lungs.
b) Systemic corticosteroids :
• The chronic use of oral GCs for the treatment of COPD is not recommended because
of an unfavorable benefit/risk ratio.
• A short course of 1-3 weeks of oral glucocorticoids may benefits in some patients of
COPD during an exacerbations.
Combinations of bronchodilators and inhaled steroids
• Fluticasone and vilanterol
• Salmeterol and Fluticasone
• Formoterol and Budesonide
• Fluticasone, umeclidinium and Vilanterol
5) Vaccination :
• All patients with COPD should receive the Influenza vaccine
annually.
• Polyvalent pneumococcal vaccine is also recommended in patients
>65yrs old.
6) Oxygen therapy :
• For more than 15 hrs per day for COPD patients in chronic hypoxia respiratory failure can
increase survival.
• The goal of oxygen therapy should be an oxygen saturation of 88-90%.
7) Surgery :
• Surgical options for treatment of severe COPD include
a) Lung transplantation
b) Bullectomy
c) Lung volume reduction
Stage Recommended Treatment
All • Avoidance of risk factors (smoking)
• Influenza vaccine annually
• Pneumococcal vaccine
• Treatment of complications
Mild COPD • Short-acting bronchodilators when needed
Moderate COPD • Regular treatment with one or more bronchodilators
Severe COPD • Regular treatment with one or more bronchodilator
• Inhaled corticosteroids for patients with repeated exacerbation or
persistent symptoms despite bronchodilator therapy
Very severe COPD • Regular treatment with one or more bronchodilator
• Inhaled corticosteroids if symptoms persist despite bronchodilator therapy
• Long term O2 therapy if chronic respiratory failure
• Surgical treatment considered
Drug therapy
Thank You…!!
Eliminate tobacco from your life before it
kills you..!!

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COPD.pptx

  • 1. Pharmacotherapy Of COPD Presented By Ms. Pranali A. Chandurkar Assistant Professor Department of Pharmacology Dr. Rajendra Gode Institute of Pharmacy, Amravati.
  • 2. Chronic Obstructive Pulmonary Disease (COPD) • Also called as Chronic Obstructive Airway Disease. • COPD is characterized by difficulty in exhaling air. • It is slowly progressive disease and irreversible. • The most common cause of COPD is Cigarette Smoking. • COPD may include diseases that cause airflow obstruction (eg., Emphysema, Chronic Bronchitis) or combination of these disorders.
  • 3. 1)Chronic Bronchitis • Chronic bronchitis is a chronic inflammation of the lower respiratory tract characterised by excessive mucous secretion, cough & dyspnea associated with recurrent infection of the lower respiratory tract. • The condition is more common in middle-aged males than females i.e., approximately 20% adult men and 5% adult women. Risk Factors : • Smoking • Air pollution (Dust, NO2, SO2, toxic fumes etc) • Genetic factor
  • 6. Sign And Symptoms • Cough • Wheezing • Shortness of breath • Chest tightness • Hypoxemia • Hypercapnia • Cyanosis
  • 7. Emphysema (Pink Puffers) • Emphysema is a form of chronic lung disease which is characterised by the irreversible enlargement of air spaces. • The most common cause is tobacco smoking and congenital α1AT deficiency. • Types : 1) Centriacinar emphysema 2) Pacinar emphysema 3) Paraseptal (Distal acinar) emphysema 4) Irregular emphysema
  • 9. Sign And Symptoms • Weight loss • Dyspnoea • Cough occur late after dyspnoea start • Wheezing • Cough • Shortness of breath • Long term mucus production • Enlarged chest
  • 10. Pharmacotherapy 1) Risk Management : • Smoking cessation is the single most effective intervention to prevent COPD or slow its progression. • It is major essential to reduce disease • progression and improve survival rate. • Use nicotine replacement product and • medication to quit smoking.
  • 11. 2) Bronchodilators : • Bronchodilators relieve bronchospasm and reduce airway obstruction by allowing increased oxygen distribution throughout the lungs and improving alveolar ventilation. • They are mostly used for the management of COPD, which are delivered through a metered-dose inhaler (MDI) by nebulization or via oral route. • Both short acting and long acting bronchodilators are used. a) Short-acting Bronchodilators : Salbutamol Ipratropium b) Long-acting Bronchodilators : Tiotropium Salmeterol Formoterol
  • 12. a) Short-acting bronchodilator inhalers • For most people with COPD, short-acting bronchodilator inhalers are the first treatment used. • Bronchodilators are medicines that make breathing easier by relaxing and widening your airways. • There are 2 types of short-acting bronchodilator inhaler: 1) β2 agonist inhalers : Salbutamol and Terbutaline 2) Antimuscarinic inhalers : Ipratropium • Short-acting inhalers should be used when you feel breathless, up to a maximum of 4 times a day. Salbutamol • It is highly selective B2 agonist • Produces bronchodilation within 5 min by relaxing the bronchiolar smooth muscle. • Action last for 2-4 hrs. • Side effects : Muscle tremor, Palpitation, Restlessness, Nervousness, Throat irritation, Ankle edema • Dose : 100-200 ug by inhalation
  • 13. Ipratropium bromide • It is a short acting inhaled anticholinergic bronchodilator. • It blocks the bronchoconstriction mainly in the larger airways. • Action last for 4-6 hrs • Inhaled anticholinergics are the bronchodilator of choice in COPD. Combination of Salbutamol and Ipratropium • DUOLIN INHALER : 100 ug + 20 ug per metered dose • DUOLIN ROTACAP : 200 ug + 40 ug per rotacap • DUOLIN RESPULES : 2.5 mg + 500ug in 2.5 ml solution
  • 14. Long-acting bronchodilator inhalers • If you experience symptoms regularly throughout the day, a long-acting bronchodilator inhaler will be recommended. • These work in a similar way to short-acting bronchodilators, but each dose lasts for at least 12 hours, so they only need to be used once or twice a day. • There are 2 types of long-acting bronchodilator inhaler: a. β2 agonist inhalers : Salmeterol, Formoterol and Indacaterol b. Antimuscarinic inhalers : Tiotropium, Glycopyronium and Aclidinium Salmeterol • It is the first long acting selective B2 agonist with slow onset of action. • Long acting B2 agonist are superior to short acting ones and equivalent to inhaled anticholinergic in COPD. • They reduces breathlessness by preventing expiratory closure of peripheral airways and abolishing the reversible components of airway obstruction. • Dose : Salmeterol 25 ug per metered dose inhaler; 2 puffs BD; severe cases 4 puffs BD
  • 15. Formoterol • It is a long-acting selective B2 agonist • Action last for 12 hrs • In comparison to Salmeterol, it has faster onset of action • Dose : 12-24 ug by inhalation twice daily. Tiotropium Bromide • It is a long acting inhaled anticholinergic bronchodilator. • Action last for 24 hrs. • Tiotropium is more effective than ipratropium in COPD. • Regular maintenance therapy with long acting anticholinergic inhalationcan reduces the episode of COPD exacerbations.
  • 16. New Drugs : • Indacaterol, Olodaterol, Vilanterol are new ultra long acting selective B2 agonist that have been approved for maintenance treatment of COPD. • They are administered by inhalation in powder form ( Indacaterol, Vilanterol) or solution form (Olodaterol) once a day. • Side effects: Cough Dizziness Nasopharyngitis. • Glycopyrronium Bromide is a long acting anticholinergic drug has been approved as a maintenance treatment of COPD. • Dose : 50ug inhalation powder per cap once a day.
  • 17. 3) Methylxanthines : • Theophylline, Aminophylline • It decreases release of histamine, other mediators and cytokines from mast cells and activated inflammatory cells. • Adverse effects : Theophylline has a narrow margin of safety. • Headache, nervousness, nausea, dyspepsia, insomnia, convulsions, delirium,shock, arrhythmias • Dose : Theophylline 100-300 mg TDS Aminophylline 100 mg tab, 250 mg/ 10 ml inj. • Theophylline used in the treatment of chronic COPD improve lung function like vital capacity and FEV1. • Theophylline used in patients who are intolerant to inhaled bronchodilators. • If patients does not achieve optimum clinical response with β2 agonist and anticholinergic then methylxyanthines are added to the regimen.
  • 18. Roflumilast • It has been approved by US-FDA for symptomatic treatment of COPD. • It is a selective PDE4 inhibitors. • It exerts antiinflammatory action, primarily in the lungs. • Lung function is improved and risk of exacerbations is reduced. • Adverse effects : Diarrhoea weight loss psychiatric disturbances
  • 19. 4) Corticostroids : • Glucocorticoids are not broncodilators. • They benefit by inhibiting inflammatory cytokine production and eosinophilic, lymphocytic infiltration of lungs. • They also reduce bronchial hyperreactivity, mucosal edema and suppress inflammatory response to AG:AB reaction or to other stimuli. a) Inhaled steroids : • Fluticasone, Budesonide • It reduces airway inflammation and help to prevent exacerbations. Fluticasone : • Fluticasone propionate is an inhaled glucocorticoid which has high potency, longer duration of action and negligible oral bioavailability. • The dose swallowed after inhalation has little propensity to produce systemic effects. • At high doses, systemic effects may be due to absorption from lungs.
  • 20. b) Systemic corticosteroids : • The chronic use of oral GCs for the treatment of COPD is not recommended because of an unfavorable benefit/risk ratio. • A short course of 1-3 weeks of oral glucocorticoids may benefits in some patients of COPD during an exacerbations.
  • 21. Combinations of bronchodilators and inhaled steroids • Fluticasone and vilanterol • Salmeterol and Fluticasone • Formoterol and Budesonide • Fluticasone, umeclidinium and Vilanterol
  • 22. 5) Vaccination : • All patients with COPD should receive the Influenza vaccine annually. • Polyvalent pneumococcal vaccine is also recommended in patients >65yrs old.
  • 23. 6) Oxygen therapy : • For more than 15 hrs per day for COPD patients in chronic hypoxia respiratory failure can increase survival. • The goal of oxygen therapy should be an oxygen saturation of 88-90%. 7) Surgery : • Surgical options for treatment of severe COPD include a) Lung transplantation b) Bullectomy c) Lung volume reduction
  • 24. Stage Recommended Treatment All • Avoidance of risk factors (smoking) • Influenza vaccine annually • Pneumococcal vaccine • Treatment of complications Mild COPD • Short-acting bronchodilators when needed Moderate COPD • Regular treatment with one or more bronchodilators Severe COPD • Regular treatment with one or more bronchodilator • Inhaled corticosteroids for patients with repeated exacerbation or persistent symptoms despite bronchodilator therapy Very severe COPD • Regular treatment with one or more bronchodilator • Inhaled corticosteroids if symptoms persist despite bronchodilator therapy • Long term O2 therapy if chronic respiratory failure • Surgical treatment considered Drug therapy
  • 25. Thank You…!! Eliminate tobacco from your life before it kills you..!!