Chronic Obstructive Pulmonary Disease (COPD) 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.
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
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