Professional Documents
Culture Documents
fully reversible..”
COPD
Normal
Damage +
Cholinergic tone
How common is COPD?
• About 13.9% of the U.S. adult population (25+
years) have been diagnosed with COPD*
1.5
1 .5
1.0
1 .0
0 .5
0.5
–59% –64% –35% +163% –7%
0 .0 0
1965 - 1998 1965 - 1998 1965 - 1998 1965 - 1998 1965 - 1998
www.goldcopd.com
New Definition
• Chronic obstructive pulmonary disease
(COPD) is a preventable and treatable disease
state characterised by airflow limitation that is
not fully reversible.
• The airflow limitation is usually progressive
and is associated with an abnormal
inflammatory response of the lungs to noxious
particles or gases, primarily caused by cigarette
smoking.
• Although COPD affects the lungs, it also
produces significant systemic consequences.
• ATS/ERS 2004
Two Major Causes of COPD
• Chronic Bronchitis is characterized by
– Chronic inflammation and excess mucus
production
– Presence of chronic productive cough
*Source: Braman, S. Update on the ATS Guidelines for COPD. Medscape Pulmonary Medicine. 2005;9(1):1.
Emphysema is characterized by
Damage to the small, sac-like units of the lung that deliver
oxygen into the lung and remove the carbon dioxide
*Source: Braman, S. Update on the ATS Guidelines for COPD. Medscape Pulmonary Medicine.
2005;9(1):1.
COPD Patients
Stereotypical pictures of COPD patients
31
• Emphysema
– Chronic cough
– Shortness of breath
– Limited activity level
Causes of COPD
Cigarette smoking
Industrial causes
• Genetic makeup
• Increasing age
hyperinflation
Reduced activity
Inactivity
capacity
Deconditioning
Spirometry
• Diagnosis
• Assessing severity
• Assessing prognosis
• Monitoring
progression
Value of Spirometry in COPD
TLC
IC
TLC VT
FRC
Volume
IC
VT
FRC
RV
RV
Normal COPD
How is COPD Treated?
• COPD can be managed, but not cured
Pulmonary rehabilitation
Pharmacologic
Supplemental oxygen
Non-invasive ventilation
Surgical remedies
Smoking Cessation and Reduced
Decline in FEV1
100
80
20 Death
0
20 30 40 50 60 70 80 90
Age (years)
Fletcher C, Peto R. Br Med J. 1977;1:1645-1648.
32
Smoking Cessation
Societal Interventions
Restriction on advertisements
Pulmonary rehabilitation
Pharmacologic
Supplemental oxygen
Non-invasive ventilation
Surgical remedies
Pulmonary Rehabilitation
Exercise
Psychosocial support
Benefits of Pulmonary
Rehabilitation
Improved activity capacity
Decrease in hospitalization
Return to work
Management of COPD
Smoking cessation
Pulmonary rehabilitation
Pharmacologic
Supplemental oxygen
Non-invasive ventilation
Surgical remedies
“Bronchodilator medications are central
to the symptomatic management of
COPD”
• Steroids
• Reduces inflammation
• Oxygen therapy
• Helps with shortness of breath
What medications are used
to prevent complications?
• Annual flu vaccine
– Reduces risk of flu and its complications
• Pneumonia vaccine
– Reduces risk of common cause of pneumonia
Short-Acting Bronchodilators:
Salbutamol/Albuterol
• Stimulates β2-receptors on airway smooth
muscle
• Onset of effect: 1-3 minutes
• Duration of action: 4-6 hrs
• Reliever/rescue medication: PRN dosing
∀ β2:β1 Selectivity
– Albuterol = 1,375:
Long-Acting Bronchodilators:
Salmeterol
• Stimulates β2-receptors on airway smooth
muscle
• Onset of effect: 20-30 minutes
• Duration of action: 12+ hrs
• Maintenance medication: 1 inhalation b.i.d.
∀ β2:β1 Selectivity
– Albuterol = 1,375:1
– Salmeterol = 85,000:1
Formoterol
• Long-acting β2-agonist
• Dosage: 12 µg b.i.d. via dry-powder inhaler
• Onset of action: 1-3 minutes
• Duration of action: dose-dependent (12-
hour duration with higher dose)
Bronchodilation
Post-ganglionic
nerve
Pre-synaptic
M2 receptors (inhibitory)
Neuromuscular ACh Post-synaptic
junction M3 receptors (facilitate)
1.5
1.4
FEV1 (L)
1.3
Post-bronchodilator
FEV1
(% predicted)
LA Bronchodilators in COPD
Drugs lung symptoms exercise decrease
function tolerance exacerbations
Salmeterol ++ + - +/-
Formoterol ++ + - +
Tiotropium +++ ++ ? ++
tiotropium salmeterol or
II + formoterol +
SABA SABA
tiotropium + salmeterol or
III salmeterol or formoterol +
formoterol tiotropium
IV
add inhaled corticosteroid
Efficacy
Compliance
Safety
Cost
Alpha 1 Antitrypsin Deficiency
Treatment
NIH National Registry showed improved survival and decreased
rate of decline in patients receiving augmentation therapy
Pulmonary rehabilitation
Pharmacologic
Supplemental oxygen
Non-invasive ventilation
Surgical remedies
Indications for O2 Therapy
Pulmonary rehabilitation
Pharmacologic
Supplemental oxygen
Non-invasive ventilation
Surgical remedies
Noninvasive Ventilation
Pulmonary rehabilitation
Pharmacologic
Supplemental oxygen
Non-invasive ventilation
Surgical remedies
Volume Reduction Surgery
Decreased PaCO2
Improved FEV1
Statins
ACE Inhibitors
Sildenafil
Osteoporosis
Useful Informational Web Sites
for COPD
www.goldcopd.com
www.ats/copd.com
www.nlhep.org