Chronic obstructive pulmonary disease (COPD) refers to chronic bronchitis and emphysema, is a preventable and somewhat treatable disease with some significant extra pulmonary effects that may contribute to the severity in individual patients

caused by noxious particles or gas, most commonly from tobacco smoking, which triggers an abnormal inflammatory response in the lung

Chronic Bronchitis: inflammatory response in the larger airways which is diagnosed clinically when symptoms of chronic cough and sputum production are presente

Emphysema: resultant destruction of the tissue lining of the lung caused by inflammation

Any patient with dyspnea; chornic cough or sputum production

NO. It is manageable throught smoking cessation, vaccinations, rehabilitation, and drug therapy (often using inhalers). Some patients go on to requiring long-term oxygen therapy or lung transplantation

Bronchodilators (beta-2 agonists, anticholinergics)

Short-acting beta-2 agonist are combined with what class of medication?

Combination of a short-acting beta-1 agonist and an anticholinergic produces greater improvements in lung function that either drug given alone. The addition of an inhaled corticosteroid to bronchodilators is approprioate for symptomatic COPD patients with more severe disesase

Influenza (each fall) and pneumococcal vaccine (x1, repeat if > 65 years old and received vaccine > 5 years ago) should be given to patients with COPD, unless contraindications exist.

Do you hvae a basic understanding of the treatment algorithm for COPD?

If a patient has alpha-1 antitrypsin deficiency, he/she may be placed on alpha-1 proteinase inhibitor (Prolastin - C) for chornic augmentation therapy

Inhaled anticholinergic bronchodilator plus oral steroids (tappered over 2 weeks)

blocks the action of acetylocholine [and decrease cyclic guanosine monophosphate (cGMP)] at parasympathetic sites in bronchial smooth muscle causing bronchodilation

Combivent or

DuoNeb

Combivent contains soya lecithin - caution in patients with a peanut allergy

bind to beta 2 receptors causing relaxation of bronchial smooth muscle, resulting in bronchodilation - inhaled route is the preferred route of administration.

Salmeterol

Formoterol

Advair Diskus

or

Advair HFA

Advair Diskus: 1 inhalation BID

Advair HFA: 2 inhalations BID