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Introduct|on

Chronlc obsLrucLlve pulmonary dlsease (CCD) ls a dlsease sLaLe characLerlzed by alrflow llmlLaLlon LhaL
ls noL fully reverslble 1hls newesL deflnlLlon CCD provlded by Lhe Clobal lnlLlaLlve for Chronlc
CbsLrucLlve Lung ulsease (CCLu) ls a broad descrlpLlon LhaL beLLer explalns Lhls dlsorder and lLs slgns
and sympLoms (CCLu World PealLh CrganlzaLlon WPC naLlonal PearL Lung and 8lood lnsLlLuLe
nPL8l 2004) AlLhough prevlous deflnlLlons have lnclude emphysema and chronlc bronchlLls under Lhe
umbrella classlflcaLlon of CCD Lhls was ofLen confuslng because mosL paLlenL wlLh CCD presenL wlLh
over lapplng slgns and sympLoms of Lhese Lwo dlsLlncL dlsease processes
CCD may lnclude dlseases LhaL cause alrflow obsLrucLlon (eg Lmphysema chronlc bronchlLls) or any
comblnaLlon of Lhese dlsorders CLher dlseases as cysLlc flbrosls bronchlecLasls and asLhma LhaL were
prevlously classlfled as Lypes of chronlc obsLrucLlve lung dlsease are now classlfled as chronlc pulmonary
dlsorders Powever asLhma ls now consldered as a separaLe dlsorder and ls classlfled as an abnormal
alrway condlLlon characLerlzed prlmarlly by reverslble lnflammaLlon CCD can coexlsL wlLh asLhma
8oLh of Lhese dlseases have Lhe same ma[or sympLoms however sympLoms are generally more varlable
ln asLhma Lhan ln CCD
CurrenLly CCD ls Lhe fourLh leadlng cause of morLallLy and Lhe 12
Lh
leadlng cause of dlsablllLy
Powever by Lhe year 2020 lL ls esLlmaLed LhaL CCD wlll be Lhe Lhlrd leadlng cause of deaLh and Lhe
flrLh leadlng cause of dlsablllLy (Sln McAllsLer Man LL al 2003) eople wlLh CCD commonly become
sympLomaLlc durlng Lhe mlddle adulL years and Lhe lncldence of Lhe dlsease lncreases wlLh age
Stat|st|cs

Wor|dw|de Stat|st|cs

lnformaLlon on Lhe prevalence of CCu was obLalned from vlLal sLaLlsLlcs healLh lnLervlew surveys
hosplLal charge records naLlonal publlcaLlons and Lhe World PealLh CrganlzaLlon (WPC) 1hese daLa
lndlcaLe LhaL CCu ls a common dlsease wlLh lmpllcaLlons for global healLh ln Lhe unlLed SLaLes
morbldlLy caused by CCu ls 4 maklng CCu Lhe fourLh leadlng cause of deaLh exceeded only by
hearL aLLacks cancer and sLroke lnLernaLlonally Lhere ls subsLanLlal varlaLlon ln deaLh raLes posslbly
reflecLlng smoklng behavlor Lype and processlng of Lobacco polluLlon cllmaLe resplraLory
managemenL and geneLlc facLors 1he Clobal CbsLrucLlve Lung ulsease lnlLlaLlve lnlLlaLed by Lhe
naLlonal PearL Lung and 8lood lnsLlLuLe and Lhe WPC alms Lo ralse awareness of Lhe lncreaslng
burden of CCu decrease morbldlLy and morLallLy promoLe furLher sLudy of Lhe condlLlon and
lmplemenL programs Lo prevenL CCu

oca| Stat|st|cs
Chronlc CbsLrucLlve ulmonary ulsease (CCu) and asLhma are 2 of Lhe leadlng causes of deaLhs ln Lhe
hlllpplnes and Lhe world

Accordlng Lo World PealLh CrganlzaLlon 600 mllllon people worldwlde suffer from CCu whlle 12 of
hlllpplne populaLlon of 90 mllllon has asLhma

1hese alarmlng sLaLlsLlcs are [usL one of Lhe challenges LhaL Lhe lnLernaLlonal and naLlonal healLh
organlzaLlons are faclng
-ew trends
-ew Drug (Da||resp) to 1reat CCD Approved
osLed Mar 01 2011 331pm
1he uS lood and urug AdmlnlsLraLlon approved roflumllasL (uallresp) a plll Laken dally Lo decrease
Lhe frequency of flareups or worsenlng of sympLoms from severe chronlc obsLrucLlve pulmonary
dlsease (CCu)
CCu ls a serlous lung dlsease LhaL makes breaLhlng dlfflculL SympLoms can lnclude breaLhlessness
chronlc cough and excesslve phlegm An exacerbaLlon can lasL up Lo several weeks and resulL ln lung
funcLlon decllne lncreased rlsk of deaLh and may be assoclaLed wlLh severe anxleLy
ClgareLLe smoklng ls Lhe leadlng cause of CCu accordlng Lo Lhe naLlonal PearL Lung and 8lood
lnsLlLuLe CCu ls Lhe fourLh leadlng cause of deaLh ln Lhe unlLed SLaLes
8oflumllasL a new drug class for Lhe LreaLmenL of CCu ls an lnhlblLor of an enzyme called
phosphodlesLerase Lype 4 (uL4) lL ls lndlcaLed for people wlLh severe CCu Lo LreaL Lhe sympLoms of
cough and excess mucus llnked Lo bronchlLls 8oflumllasL ls noL lnLended Lo LreaL anoLher form of CCu
whlch lnvolves prlmary emphysema
CCu ls a serlous dlsease LhaL geLs worse over Llme" sald CurLls 8osebraugh Mu MP dlrecLor of
Lhe Cfflce of urug LvaluaLlon ll ln Lhe luA's CenLer for urug LvaluaLlon and 8esearch new LreaLmenL
opLlons LhaL reduce frequency of flareups or exacerbaLlons are lmporLanL ln helplng paLlenLs wlLh CCu
assoclaLed wlLh chronlc bronchlLls and a hlsLory of exacerbaLlons ln managlng Lhls deblllLaLlng dlsease"
1he safeLy and effecLlveness of roflumllasL was demonsLraLed ln Lwo hase 3 cllnlcal sLudles LhaL
lncluded more Lhan 1300 paLlenLs ages 40 and older who recelved roflumllasL 1hose LreaLed had a
hlsLory of CCu assoclaLed wlLh chronlc bronchlLls and had experlenced an exacerbaLlon of Lhe dlsease
durlng Lhe 12 monLhs prlor Lo beglnnlng LreaLmenL
1he luA approved roflumllasL wlLh a medlcaLlon gulde lnformlng paLlenLs of Lhe poLenLlal rlsks of
menLal healLh problems lncludlng changes ln mood Lhlnklng or behavlor as well as unexplalned welghL
loss
8oflumllasL should noL be used Lo LreaL sudden breaLhlng problems (acuLe bronchospam) and ls noL
recommended for people younger Lhan 18 years 1he mosL common slde effecLs reporLed by Lhose
recelvlng roflumllasL lncluded dlarrhea nausea headache lnsomnla back paln decreased appeLlLe and
dlzzlness
8oflumllasL ls markeLed by SL Loulsbased loresL harmaceuLlcals a subsldlary of loresL LaboraLorles
hLLp//wwwwellspherecom/generalmedlclnearLlcle/newdrugdallrespLoLreaLcopd
approved/1372906

Cverv|ew of the d|sease
WhaL ls CCu?
CCu or chronlc obsLrucLlve pulmonary (uLLmunary) dlsease ls a progresslve dlsease LhaL makes lL
hard Lo breaLhe rogresslve means Lhe dlsease geLs worse over Llme
CCu can cause coughlng LhaL produces large amounLs of mucus (a sllmy subsLance) wheezlng
shorLness of breaLh chesL LlghLness and oLher sympLoms
ClgareLLe smoklng ls Lhe leadlng cause of CCu MosL people who have CCu smoke or used Lo smoke
LongLerm exposure Lo oLher lung lrrlLanLs such as alr polluLlon chemlcal fumes or dusL also may
conLrlbuLe Lo CCu
Cverv|ew
1o undersLand CCu lL helps Lo undersLand how Lhe lungs work 1he alr LhaL you breaLhe goes down
your wlndplpe lnLo Lubes ln your lungs called bronchlal Lubes or alrways
WlLhln Lhe lungs your bronchlal Lubes branch lnLo Lhousands of smaller Lhlnner Lubes called
bronchloles 1hese Lubes end ln bunches of Llny round alr sacs called alveoll (alvLLuhleye)
Small blood vessels called caplllarles run Lhrough Lhe walls of Lhe alr sacs When alr reaches Lhe alr sacs
Lhe oxygen ln Lhe alr passes Lhrough Lhe alr sac walls lnLo Lhe blood ln Lhe caplllarles AL Lhe same Llme
carbon dloxlde (a wasLe gas) moves from Lhe caplllarles lnLo Lhe alr sacs 1hls process ls called gas
exchange
1he alrways and alr sacs are elasLlc (sLreLchy) When you breaLhe ln each alr sac fllls up wlLh alr llke a
small balloon When you breaLhe ouL Lhe alr sacs deflaLe and Lhe alr goes ouL
ln CCu less alr flows ln and ouL of Lhe alrways because of one or more of Lhe followlng
O 1he alrways and alr sacs lose Lhelr elasLlc quallLy
O 1he walls beLween many of Lhe alr sacs are desLroyed
O 1he walls of Lhe alrways become Lhlck and lnflamed
O 1he alrways make more mucus Lhan usual whlch Lends Lo clog Lhem




-orma| ungs and ungs W|th CCD

llgure A shows Lhe locaLlon of Lhe lungs and alrways ln Lhe body 1he lnseL lmage shows a deLalled
crosssecLlon of Lhe bronchloles and alveoll llgure 8 shows lungs damaged by CCu 1he lnseL lmage
shows a deLalled crosssecLlon of Lhe damaged bronchloles and alveolar walls
ln Lhe unlLed SLaLes Lhe Lerm CCu lncludes Lwo maln condlLlonsemphysema (emflSLma) and
chronlc bronchlLls (bronklLls) (noLe 1he PealLh 1oplcs arLlcle abouL bronchlLls dlscusses boLh acuLe
and chronlc bronchlLls)
ln emphysema Lhe walls beLween many of Lhe alr sacs are damaged causlng Lhem Lo lose Lhelr shape
and become floppy 1hls damage also can desLroy Lhe walls of Lhe alr sacs leadlng Lo fewer and larger
alr sacs lnsLead of many Llny ones lf Lhls happens Lhe amounL of gas exchange ln Lhe lungs ls reduced
ln chronlc bronchlLls Lhe llnlng of Lhe alrways ls consLanLly lrrlLaLed and lnflamed 1hls causes Lhe llnlng
Lo Lhlcken LoLs of Lhlck mucus forms ln Lhe alrways maklng lL hard Lo breaLhe
MosL people who have CCu have boLh emphysema and chronlc obsLrucLlve bronchlLls 1hus Lhe
general Lerm CCu ls more accuraLe

athophys|o|ogy

S|gns and Symptoms of Chron|c Cbstruct|ve u|monary D|sease
Many of Lhe slgns of CCu are caused by Lhe bodys aLLempL Lo compensaLe for a damaged resplraLory
sysLem SympLoms develop as a dlrecL resulL of dlsease processes
S|gns CCD
Slgns of CCu are consequences of Lhe anaLomlcal changes caused by Lhe dlsease barrel chesL pursed
llp breaLhlng producLlve cough and cyanosls
8arre| Chest
Cne Lelllng slgn ls Lhe change ln Lhe shape of Lhe chesL known as barrel chesL When Lhe lungs become
enlarged Lhe dlaphragm ls dlsplaced downward and ls unable Lo conLracL efflclenLly lurLhermore Lhe
chesL wall ls enlarged maklng accessory breaLhlng muscles (muscles ln Lhe neck upper chesL and
beLween Lhe rlbs) less efflclenL as well 1hese changes conLrlbuLe Lo shorLness of breaLh 1hls becomes
apparenL when a person wlLh CCu Lrles do someLhlng wlLh Lhe arms ralsed above Lhe head such as
changlng a llghL bulb ln a celllng flxLure and becomes shorL of breaLh
1o compensaLe a person wlLh CCu ofLen slLs leanlng forward wlLh Lhelr arms supporLed on a surface ln
fronL of Lhem or on Lhelr knees 1hls sLablllzes Lhe upper chesL and shoulders and allows Lhem Lo use
accessory resplraLory muscles more efflclenLly
ursed|p 8reath|ng
8ecause alrflow ouL of Lhe lungs becomes llmlLed exhalaLlon Lakes longer 8ecause Lhe alveoll lose Lhelr
elasLlclLy one Lrles Lo shorLen Lhe Llme needed for exhalaLlon by forcefully exhallng unforLunaLely
forced exhalaLlon lncreases pressure on Lhe lungs and causes sLrucLurally weakened alrways Lo collapse
1o prevenL alrways from closlng durlng forced exhalaLlon pursedllp breaLhlng ls used 1he llps are
narrowed LogeLher whlch slows exhalaLlon aL Lhe mouLh 1hls keeps poslLlve pressure ln Lhe alrways
Lhus prevenLlng Lhelr collapse and allowlng some forced exhalaLlon
roduct|ve Cough
A producLlve cough ls caused by lnflammaLlon and excesslve amounLs of mucus ln Lhe alrways Coughlng
becomes less effecLlve because of obsLrucLed alrflow
Cyanos|s
eople who have a poor supply of oxygen usually have a blulsh Llnge Lo Lhelr skln llps and nallbeds
called cyanosls
Symptoms of CCD
Shortness of 8reath (Dyspnea)
uyspnea Lhe mosL common sympLom of CCu comes on gradually and ls flrsL noLlced durlng physlcal
exerLlon or durlng acuLe exacerbaLlons lL usually beglns when paLlenLs are ln Lhelr 60s and 70s and
slowly becomes more promlnenL lL ls closely assoclaLed wlLh lung funcLlon decllne and ls noL always
assoclaLed wlLh low oxygen ln Lhe blood
aLlenLs ofLen wonder why dyspnea occurs so long afLer beglnnlng Lo smoke say 30 Lo 60 years laLer
Some paLlenLs have even qulL smoklng several years before sympLoms appear 1he maln reason ls LhaL
lung funcLlon decllnes slowly wlLh age even ln a nonsmoker AL approxlmaLely age 30 people begln Lo
lose lung funcLlon aL a raLe of 23 Lo 30 mL/year of forced explraLory volume ln 1 second (lLv1 see
SplromeLry) eople who smoke lose lung funcLlon aL a more rapld raLe approxlmaLely 123 mL/year
8ecause Lhe lungs have a conslderable amounL of reserve a large porLlon musL become nonfuncLlonal
before sympLoms occur lL can Lake more Lhan 30 years Lo lose enough lung funcLlon Lo experlence
sympLoms
When a person qulLs smoklng Lhe loss ln funcLlon slows Lo approxlmaLely Lhe raLe of a nonsmoker lf
smoklng has already desLroyed a large porLlon of Lhe lungs Lhe Lhreshold wlll be reached evenLually aL
a raLe of decllne of 30 mL/year lnsLead of 123 mL/year WlLhouL qulLLlng decllne would conLlnue aL a
raLe of 123 mL/year CuallLy of llfe can lmprove by qulLLlng even lf lung funcLlon has already decllned
Chron|c Cough
Chronlc cough Lyplcally beglns as a mornlng cough and slowly progresses Lo an allday cough 1he cough
usually produces small amounLs of spuLum (less Lhan 60 mL/day) and ls clear or whlLlsh buL may be
dlscolored SpuLum producLlon decreases when one qulLs smoklng
1he progresslon of Lhe coughs frequency ls so slow LhaL a person usually LoleraLes lL for a couple of
years before seelng a docLor Any change ln a chronlc cough or a new cough ln a smoker or paLlenL wlLh
CCu should be Lhoroughly evaluaLed by a physlclan
Wheez|ng
Wheezlng ls Lhe hlghplLched sound of alr passlng Lhrough narrowed alrways A person wlLh CCu may
wheeze durlng an acuLe exacerbaLlon or chronlcally SomeLlmes Lhe wheezlng ls heard only aL nlghL or
wlLh exerLlon 8ronchodllaLors can relleve wheezlng qulckly (see 8ronchodllaLors)
nemoptys|s
CCu ls one of Lhe more common causes of hemopLysls (coughlng up blood) lL usually occurs durlng an
acuLe exacerbaLlon when Lhere ls a loL of coughlng wlLh purulenL spuLum (spuLum conLalnlng pus)
usually Lhere are only very small amounLs of blood sLreaklng Lhe spuLum PemopLysls may be a slgn of
lung cancer ln a paLlenL wlLh CCu so any blood appearlng ln Lhe spuLum should be broughL Lo a
docLors aLLenLlon
We|ght oss

aLlenLs wlLh severe CCu work hard and burn a loL of calorles [usL breaLhlng 1hese paLlenLs also
become shorL of breaLh ln Lhe very acL of eaLlng and so may noL eaL enough Lo replace Lhe calorles Lhey
use
ower Lxtrem|ty Ldema
ln severe cases of CCu pulmonary arLery pressures lncrease and Lhe rlghL venLrlcle of Lhe hearL
conLracLs less efflclenLly When Lhe hearL ls unable Lo pump enough blood Lo meeL Lhe needs of Lhe
kldneys and llver edema (swelllng) ln Lhe feeL ankles and lower legs resulLs lL can also cause Lhe llver
Lo become swollen and Lender or fluld Lo accumulaLe ln Lhe abdomen (asclLes) A dlsLended abdomen
can be a slgn of asclLes
hLLp//wwwhealLhcommunlLlescom/copd/sympLomsshLml
Publication Review By: Stanley J. Swierzewski, III, M.D.
Published: 01 Jun 2000
Last Modified: 03 Nov 2011

D|agnost|c rocedures
D|agnost|c 1ests
uesplLe Lhe wldespread lncldence and serlousness of CCu sLudles sLrongly suggesL LhaL lL ls
underdlagnosed especlally ln women Some experLs recommend LhaL any adulL smoker who complalns
of a dally cough should be screened for CCu ln one 2002 sLudy nearly half of paLlenLs over 60 who
regularly smoked had CCu
Med|ca| and ersona| n|story
1he docLor wlll requesL a hlsLory LhaL evaluaLes Lhe paLlenLs rlsk facLors 8lsk facLors lnclude
O Lxposure Lo lndusLrlal polluLanLs
O Low exerclse capaclLy (such as Lrouble cllmblng sLalrs or dlfflculLy walklng for more Lhan a
cerLaln dlsLance)
O asL and presenL smoklng
hys|ca| Lxam|nat|on
Appeotooce no changes ln physlcal appearance are usually presenL wlLh mlldLomoderaLe CCu ln
advanced CCu paLlenLs wlLh emphysema may be wasLed and Lhln wlLh normalcolored plnk skln
whlle Lhose wlLh chronlc bronchlLls may have blulsh llps and flngers be obese and may have swollen
feeL and legs 8reaLhlng may be rapld and shallow done Lhrough pursed llps wlLh prolonged exhales
1he paLlenL wlll be asked Lo cough and produce spuLum lf posslble
est xomlootloo 1he physlclan wlll nexL perform a slmple examlnaLlon of Lhe chesL area wlLh a
sLeLhoscope Lo llsLen for
O CreplLaLlons a nolse resembllng a paper bag belng rumpled
O ulmlnlshed or dlsLanL breaLh sounds
O Slgns of pulmonary hyperLenslon
O Wheezlng or gurgllng sounds
CLher flndlngs may lnclude
O 8reaLhlessness when Lhe paLlenL lles flaL
O LlevaLed pressure ln Lhe velns
u|monary Iunct|on 1ests (Sp|rometry)
1he besL LesLs for dlagnoslng CCu and seelng how well lL responds Lo LreaLmenL are pulmonary
funcLlon LesLs 1he goldsLandard LesL for paLlenLs wlLh resplraLory sympLoms ls splromeLry SplromeLry
measures Lhe volume and force of alr as lL ls exhaled from Lhe lungs lL measures alrway obsLrucLlon can
ldenLlfy CCu early and Lhe resulLs are sLandardlzed so Lhey are always conslsLenL
1he paLlenL ls asked Lo breaLhe ln and Lo exhale forcefully lnLo an lnsLrumenL 1hls ls repeaLed several
Llmes 1he force of Lhe alr ls Lhen measured lrom Lhe resulLs Lhe physlclan deLermlnes Lwo lmporLanL
values
@e fotceJ vltol copoclty (lv% lvC ls Lhe moxlmom volome of olt LhaL can be exhaled (breaLhed ouL)
wlLh force and ls an lndlcaLor of lung slze elasLlclLy and how well Lhe alr passages open and close
@e fotceJ expltototy volome lo ooe secooJ (lv1% lLv1 ls Lhe moxlmom volome of olt exoleJ lo 1
secooJ Alrflow ls consldered Lo be llmlLed lf Lhe ouLflow of forced exhalaLlon sLays low over Lhe course
of 1 second eople wlLh CCu have a decllne ln lLv1 over Llme lLv1 ls measured as percenL of
predlcLed
O ModeraLe CCu ls an lLv1 30 80 of predlcLed
O Severe CCu ls an lLv1 30 30 of predlcLed
O 1he raLlo of lLv1 Lo lvC (lLv1/lvC) ls less Lhan 70 of normal regardless of wheLher Lhe
paLlenL has an lLv1 greaLer Lhan 80 or less Lhan 30


SplromeLry ls a palnless sLudy of alr volume and flow raLe wlLhln Lhe lungs SplromeLry ls frequenLly used
Lo evaluaLe lung funcLlon ln people wlLh obsLrucLlve or resLrlcLlve lung dlseases such as asLhma or cysLlc
flbrosls
1ests for Measur|ng the Ab|||ty of the ung to Lxchange Cxygen and Carbon D|ox|de
Attetlol 8looJ Cos 1he physlclan may requesL an arLerlal blood gas LesL Lo deLermlne Lhe amounL of
oxygen and carbon dloxlde ln Lhe blood (lLs sotototloo% Low oxygen (hypoxla) and hlgh carbon dloxlde
(hypercapnla) levels ofLen lndlcaLe chronlc bronchlLls buL noL always emphysema A blood gas analysls
LhaL shows very low oxygen levels ls useful for deLermlnlng whlch paLlenLs would beneflL from oxyqeo
tetopy (see below) 1hls procedure Lyplcally lnvolves drawlng blood from an arLery ln Lhe wrlsL

1he pulse of an arLery deLermlnes Lhe locaLlon of an arLerlal sLlck 1he prlmary reason for Laklng blood
from an arLery raLher Lhan a veln ls Lo measure blood gases 8ecause arLerlal blood ls oxygenaLed blood
flowlng dlrecLly from Lhe hearL analysls of arLerlal blood can deLermlne Lhe chemlsLry of Lhe blood
before lL ls used by Lhe Llssues
lolse Oxlmetty @est A safe and palnless LesL for measurlng oxygen ln Lhe blood ls called pulse oxlmeLry
whlch lnvolves placlng a probe on Lhe flnger or ear lobe 1he probe emlLs Lwo dlfferenL llghLs and Lhe
amounL of each llghL Lhe blood absorbs ls relaLed Lo how much oxygen Lhe red blood cells carry 1hls
LesL measures only oxygen ln Lhe blood however and noL carbon dloxlde 8esulLs should be Laken
LogeLher wlLh oLher LesLs Lo deLermlne Lhe need for medlcaLlon or oxygen Lherapy
otboo MoooxlJe ulffosloq opoclty 1he lung carbon monoxlde dlffuslng capaclLy (uLCC) LesL
deLermlnes how effecLlvely gases are exchanged beLween Lhe blood and alrways ln Lhe lungs aLlenLs
should noL eaL or exerclse before Lhe LesL and Lhey should noL have smoked for 24 hours
1he paLlenL lnhales a mlxLure of carbon monoxlde hellum and oxygen and holds hls or her breaLh for
abouL 10 seconds 1he gas levels are Lhen analyzed from Lhe exhaled breaLh 8esulLs can help physlclans
dlfferenLlaLe emphysema from chronlc bronchlLls and asLhma aLlenLs wlLh emphysema have lower
uLCC resulLs lndlcaLed by a reduced ablllLy Lo Lake up oxygen Such resulLs are also lmporLanL ln helplng
Lo deLermlne approprlaLe candldaLes for lung reducLlon surgery Carbon monoxlde levels LhaL are 20
or less Lhan predlcLed values pose a very hlgh rlsk for poor survlval
xoleJ 8teot 1he measuremenL of nlLrlc oxlde (nC) ln exhaled breaLh can be a slmple meLhod of
dlagnoslng CCu and monlLorlng Lhe effecLs of Lherapy ln mosL paLlenLs wlLh CCu no levels are below
normal Levels above normal ln a paLlenL wlLh CCu lndlcaLe LhaL Lhe person also has asLhma

Lung dlffuslon LesLlng measures how well oxygen passes from Lhe alr sacs ln Lhe lungs lnLo Lhe blood
Imag|ng 1ests
est \koys ChesL xrays are ofLen performed buL Lhey are noL very useful for deLecLlng early CCu
8y Lhe Llme an xray reveals Lhe dlsease Lhe paLlenL ls well aware of Lhe condlLlon
Clear slgns of CCu lnclude Lhe followlng
O Abnormally large amounLs of alr spaces ln Lhe lung
O A flaLLened dlaphragm
O A smaller hearL lf hearL fallure ls presenL however Lhe hearL becomes enlarged and Lhere may
noL be slgns of overlnflaLed lungs
O LxaggeraLed lung lnflaLlon ln upper areas
O Larger amounLs of alr ln Lhe lower lungs ln paLlenLs wlLh A1AurelaLed emphysema
ChesL xrays are rarely useful for dlagnoslng chronlc bronchlLls alLhough Lhey someLlmes show mlld
scarrlng and Lhlckened alrway walls
ompoteJ @omoqtopy CompuLed Lomography (C1) scans can accuraLely assess Lhe severlLy of CCu
and may be used Lo deLermlne Lhe slze of Lhe alr pockeLs (bolloe% ln Lhe lungs ln one sLudy 3
dlmenslonal C1 was used Lo vlsuallze Lhe alrways ln a manner ln whlch Lhelr dlameLer could be
measured ln Lhls sLudy alrflow llmlLaLlon ln CCu was seen Lo be relaLed Lo Lhe dlmenslons of Lhe
small raLher Lhan Lhe large alrways
Cther 1ests for CCD
-oolovoslve MetoJs fot uetetmloloq 5evetlty CuesLlonnalres and shorL exerclse LesLs are very useful
for deLermlnlng Lhe severlLy of CCu
@est fot olpo1 ootlttypslo Jeflcleocy hyslclans wlll Lyplcally LesL for Lhe proLecLlve enzyme alpha1
anLlLrypsln ln CCu paLlenLs who are nonsmokers and who develop emphysema ln Lhelr 30s
AJJltloool 8looJ ooJ 5potom @ests AddlLlonal LesLs may be requlred lf Lhe physlclan suspecLs oLher
medlcal problems lf pneumonla ls presenL for lnsLance blood and spuLum LesLs and culLures may be
performed Lo deLermlne Lhe cause of lnfecLlon
8toocoJllotot olleoqe 1he sympLoms of asLhma are generally relleved by uslng a bronchodllaLor
aLlenLs wlLh CCu Lyplcally have a llmlLed response Lo bronchodllaLlon A bronchodllaLor challenge LesL
may help dlsLlngulsh beLween Lhe Lwo dlseases Some paLlenLs wlLh CCu experlence llmlLed and
Lemporary lmprovemenL ln lLv1 30 43 mlnuLes afLer lnhallng medlcaLlon from a meLered dose lnhaler
Powever Lhelr alrflow remalns poor
8eference
8evlew uaLe 3/16/2011
8evlewed 8y Parvey Slmon Mu LdlLorlnChlef AssoclaLe rofessor of Medlclne Parvard Medlcal
School hyslclan MassachuseLLs Ceneral PosplLal Also revlewed by uavld Zleve Mu MPA Medlcal
ulrecLor AuAM lnc

AuAM lnc ls accredlLed by u8AC also known as Lhe Amerlcan AccredlLaLlon PealLhCare Commlsslon
(wwwuracorg) u8ACs accredlLaLlon program ls an lndependenL audlL Lo verlfy LhaL AuAM follows
rlgorous sLandards of quallLy and accounLablllLy AuAM ls among Lhe flrsL Lo achleve Lhls lmporLanL
dlsLlncLlon for onllne healLh lnformaLlon and servlces Learn more abouL AuAMs edlLorlal pollcy
edlLorlal process and prlvacy pollcy AuAM ls also a foundlng member of PlLLhlcs and subscrlbes Lo
Lhe prlnclples of Lhe PealLh on Lhe neL loundaLlon (wwwhonch)

ADAM Copyr|ght
1he lnformaLlon provlded hereln should noL be used durlng any medlcal emergency or for Lhe dlagnosls
or LreaLmenL of any medlcal condlLlon A llcensed medlcal professlonal should be consulLed for dlagnosls
and LreaLmenL of any and all medlcal condlLlons Call 911 for all medlcal emergencles Llnks Lo oLher
slLes are provlded for lnformaLlon only Lhey do noL consLlLuLe endorsemenLs of Lhose oLher slLes
1997 2008 AuAM lnc Any dupllcaLlon or dlsLrlbuLlon of Lhe lnformaLlon conLalned hereln ls sLrlcLly
prohlblLed
hLLp//healLhnyLlmescom/healLh/guldes/dlsease/chronlcobsLrucLlvepulmonarydlsease/dlagnosLlc
LesLshLml




MLDICA MA-AGLML-1 CI 1nL nSICCGIC LIILC1
Med|cat|ons
Ant|cho||nerg|c Agents
AnLlchollnerglc agenLs relax Lhe bronchlal muscles 1hey are generally lnhaled and acL as a
bronchodllaLor over Llme AlLhough bronchodllaLlon does noL have much effecL on lung funcLlon and
does noL change Lhe overall course of Lhe dlsease Lhe medlcaLlon helps lmprove breaLhlessness ablllLy
Lo exerclse and quallLy of llfe
8tooJs ooJ 8eoeflts AnLlchollnerglcs used for CCu lnclude shorLacLlng lpraLroplum (ALrovenL) and
longacLlng LloLroplum (Splrlva) 1hey are consldered sLandard malnLenance medlcaLlons for CCu
A slngle lnhaler conLalnlng boLh lpraLroplum and Lhe common beLa2agonlsL albuLerol (ComblvenL) may
prove Lo be beLLer Lhan elLher medlcaLlon alone AnLlchollnerglcs LargeL Lhe cenLral alrways and beLa
agonlsLs LargeL Lhe smaller alrways whlch explalns Lhe posslble addlLlve beneflLs of Lhe comblnaLlon
CLher comblnaLlons are belng explored LongacLlng anLlchollnerglc medlcaLlons are belng admlnlsLered
along wlLh lnhaled corLlcosLerolds and longacLlng beLaagonlsLs Whlle Lhe comblnaLlon may noL reduce
Lhe number of exacerbaLlons lL lmproves lung funcLlon and quallLy of llfe and reduces hosplLallzaLlons
5lJe ffects AnLlchollnerglcs have few severe slde effecLs 1hey are less llkely Lo lmpalr sleep Lhan Lhe
oLher sLandard lnhaled medlcaLlons 1he slde effecLs of resplraLory anLlchollnerglc agenLs lnclude mlld
cough and dry mouLh
8eta2Agon|sts
When anLlchollnerglcs are no longer enough and someLlmes ln place of an anLlchollnerglc Lhe docLor
wlll prescrlbe a beLa2agonlsL CCLu guldellnes recommend LhaL all paLlenLs wlLh CCu sLages ll lv
Lake a longacLlng beLa2agonlsL
5ottActloq 8eto2oqoolsts ShorLacLlng bronchodllaLors are Lhe prlmary medlcaLlons for mosL CCu
paLlenLs AlbuLerol (rovenLll venLolln) ls Lhe sLandard shorLacLlng beLa2agonlsL CLhers lnclude
O 8lLolLerol (1ornalaLe)
O lsoeLharlne (8ronkomeLer 8ronkosol) whlch ls avallable ln nebullzers
O lsoproLerenol (lsuprel norlsodrlne Medlhalerlso)
O MeLaproLerenol (AlupenL MeLaprel)
O lrbuLerol (Maxalr)
O 1erbuLallne (8reLhlne 8reLhalre 8rlcanyl)
newer beLa2agonlsLs lncludlng levalbuLerol (xopenex) have more speclflc acLlons Lhan Lhe sLandard
agenLs MosL are lnhaled and are effecLlve for 3 6 hours
ooqActloq 8eto2Aqoolsts LongacLlng beLa2agonlsLs salmeLerol (SerevenL) and formoLerol (loradll)
are provlng Lo be parLlcularly effecLlve as longLerm malnLenance Lherapy for CCu Ma[or analyses
suggesL Lhey reduce exacerbaLlons by 20 23 1hey may help prevenL bacLerla from bulldlng up on Lhe
alrways and may offer real lmprovemenLs ln lung funcLlon unllke shorLacLlng forms Lhese beLa2
agonlsLs may even have anLllnflammaLory properLles ln 2007 Lhe luA approved a nebullzed
formulaLlon of formoLerol for Lhe LreaLmenL of CCu unLll recenLly only shorLacLlng nebullzers were
avallable
lnhalers LhaL comblne a longacLlng beLa2agonlsL and a corLlcosLerold (such as Advalr SereLlde and
SymblcorL) are more effecLlve Lhan elLher agenL alone reduclng exacerbaLlons by 33 and lmprovlng
exerclse endurance
5lJe ffects Slde effecLs of boLh longand shorLacLlng beLa2agonlsLs lnclude anxleLy Lremor
resLlessness and headaches aLlenLs may experlence fasL and lrregular hearLbeaLs A physlclan should
be noLlfled lmmedlaLely lf such slde effecLs occur parLlcularly ln people wlLh exlsLlng hearL condlLlons
Such paLlenLs face an lncreased rlsk for sudden deaLh from hearLrelaLed causes 1hls rlsk ls hlgher wlLh
oral or nebullzed agenLs buL Lhere have also been reporLs of hearL aLLacks and anglna ln some paLlenLs
uslng lnhaled beLa2agonlsLs
oss of ffectlveoess ooJ OvetJose 1here has been some concern LhaL shorLacLlng beLa2agonlsLs may
become less effecLlve when Laken regularly over Llme lncreaslng Lhe rlsk of overuse 1he degree Lo
whlch Lhls affecLs Lhe alrways ls uncerLaln ln some sLudles Lhe duraLlon of acLlon has decllned wlLh use
buL Lhe peak effecL appears Lo be preserved maklng Lhese drugs sLlll useful for acuLe aLLacks 8egular
use of looqoctloq beLa2agonlsLs may reduce Lhe effecL of shorLacLlng forms
A ma[or concern ls LhaL paLlenLs who percelve beLa2agonlsLs as belng less effecLlve may overuse Lhem
Cverdose can be serlous and ln rare cases even llfe LhreaLenlng parLlcularly ln paLlenLs wlLh hearL
dlsease or asLhma
Cort|costero|ds
CorLlcosLerolds are powerful anLllnflammaLory drugs
Otol ottlcostetolJs Cral corLlcosLerolds are reserved for Lhe LreaLmenL of CCu exacerbaLlons and
research flnds LhaL Lhey are preferable Lo lnhaled corLlcosLerolds for Lhls purpose 1hey speed Lhe Llme
Lo recovery and reduce Lhe lengLh of Lhe hosplLal sLay buL appear Lo have no longLerm beneflL 1hey
shouldnL be regularly used for sLable dlsease because of Lhe lncreased rlsk of slde effecLs
ooleJ ottlcostetolJs lnhaled corLlcosLerolds (lCS) are Lhe malnsLay of asLhma Lherapy 1helr use ln
CCu ls conLroverslal uurlng Lhe flrsL 6 monLhs of use lCS may lmprove lung funcLlon AfLer 6 monLhs
lung funcLlon resumes lLs decllne 1here ls also evldence LhaL lCS lncreases Lhe rlsk of dylng from
pneumonla ln paLlenLs wlLh CCu lCS should be reserved for paLlenLs wlLh severe CCu and frequenL
exacerbaLlons
Comblnlng a longacLlng bronchodllaLor (salmeLerol) wlLh a corLlcosLerold (fluLlcasone) appears Lo
lmprove survlval and reduce exacerbaLlons ln paLlenLs wlLh severe CCu compared Lo slngledrug
LreaLmenL Powever furLher sLudles are needed Lo deLermlne wheLher Lhls comblnaLlon mlghL lncrease
Lhe number of adverse slde effecLs
1heophy|||ne and Cther Methy|xanth|nes
MeLhylxanLhlnes (prlmarlly slowrelease Lheophylllne) are also bronchodllaLors 1hese drugs are used ln
paLlenLs wlLh more severe exacerbaLlons when Lhere ls an lncompleLe response Lo bronchodllaLors
corLlcosLerolds oxygen or anLlbloLlcs
1hese agenLs do noL slgnlflcanLly lmprove lung funcLlon sympLoms or overall ouLcomes when used for
acuLe exacerbaLlons Some experLs belleve LhaL Lhe modesL beneflLs do noL ouLwelgh Lhe rlsk of Loxlc
effecLs commonly assoclaLed wlLh Lhese agenLs 1hese slde effecLs are generally relaLed Lo Lhe amounL
of Lheophylllne ln Lhe blood buL can lnclude
O Abdomlnal paln
O AnxleLy
O ularrhea
O Lxcess urlnaLlon (dluresls)
O lrregular hearLbeaL (arrhyLhmla) and palplLaLlons
O Peadache
O PearLburn
O lnsomnla
O Loss of appeLlLe
O nausea
O 8eflux
O 8esLlessness
O Selzures
O 1remor
O vomlLlng
Adm|n|ster|ng Inha|ed Drugs
Many CCu drugs are lnhaled uslng meLered dose lnhalers dry powder lnhalers or nebullzers
MeteteJuose oolet 1he sLandard devlce for CCu medlcaLlon ls Lhe meLereddose lnhaler (Mul) 1hls
devlce allows preclse doses Lo be dellvered dlrecLly Lo Lhe lungs A holdlng chamber or spacer lmproves
dellvery by glvlng Lhe paLlenL more Llme Lo lnhale Lhe medlcaLlon
8teotActlvoteJ uty lowJet oolets ury powder lnhalers (uls) dellver a powdered form of drug
dlrecLly lnLo Lhe lungs uls are as effecLlve as Muls and are easler Lo manage PumldlLy or exLreme
LemperaLures can affecL ul performance so Lhese devlces should noL be sLored ln humld places (such
as baLhroom cablneLs) or locaLlons sub[ecL Lo hlgh LemperaLures (such as glove comparLmenLs durlng
summer monLhs)
Otet nooJnelJ oolets 8esplmaL dellvers a flnemlsL spray LhaL ls creaLed by forclng Lhe llquld
medlcaLlon Lhrough nozzles lL does noL use any propellanL
-ebollzets A nebullzer ls a devlce LhaL admlnlsLers Lhe drug ln a flne spray LhaL Lhe paLlenL breaLhes ln
nebullzers are ofLen used ln hosplLal seLLlngs or when Lhe paLlenL cannoL use an lnhaler

1hls meLereddose lnhaler ls a qulck way of admlnlsLerlng medlclne dlrecLly lnLo Lhe bronchlal
passageways Lo promoLe clearer breaLhlng
Med|c|nes 1hat oosen ung Secret|ons
aLlenLs wlLh perslsLenL coughlng and spuLum ofLen use agenLs LhaL loosen secreLlons and help move
Lhem ouL of Lhe lungs
xpectotoots LxpecLoranLs such as gualfenesln (found ln common cough remedles) sLlmulaLe Lhe flow
of fluld ln Lhe alrways and help move secreLlons uslng Lhe moLlon of cllla (Lhe halrllke sLrucLures ln Lhe
lung) and coughlng LxpecLoranLs have noL been shown Lo beneflL paLlenLs wlLh CCu
Mocolytlcs MucolyLlcs conLaln lngredlenLs LhaL make spuLum more waLery and easler Lo cough up Cne
of Lhese lngredlenLs aceLylcysLelne also acLs as an anLloxldanL whlch could provlde addlLlonal beneflL
Lo people wlLh CCu 1he mosL effecLlve mucolyLlc ls sLopplng smoklng AnLlchollnerglcs appear Lo
decrease Lhe producLlon of mucus 8eLa2agonlsLs and Lheophylllne lmprove mucus clearance
Cther Med|cat|ons
5electlve lospoJlestetose4 olbltots CllomllasL (Arlflo) and roflumllasL (uaxas) are selecLlve
phosphodlesLerase4 (uL4) lnhlblLors 1hese medlcaLlons block uL4 an enzyme overproduced ln
CCu and asLhma LhaL causes lnflammaLlon ln Lhe alrways 1he luA has approved cllomllasL for Lhe
LreaLmenL of CCu and asLhma Approval of roflumllasL ls pendlng Cne sLudy of cllomllasL found LhaL
Lhe drug slgnlflcanLly decreased exacerbaLlons and lncreased quallLy of llfe ln oLher research rofumllasL
slgnlflcanLly lmproved lung funcLlon ln paLlenLs wlLh severe sLable CCu
5totlos aLlenLs wlLh CCu are aL an lncreased rlsk of deaLh from coronary arLery dlsease Some sLudles
have found an assoclaLlon beLween sLaLln use and CCu 1he anLllnflammaLory properLles of sLaLln
medlcaLlons mlghL help slow lung funcLlon decllne or help ln Lhe survlval of an exacerbaLlon especlally
ln longLlme smokers and people who have recenLly qulL 1hese effecLs have yeL Lo be explalned or
proven
Ant|b|ot|cs
@teotloq Acote 8toocltls ot loeomoolo lo Olu lotleots eople wlLh CCu are aL helghLened rlsk for
pneumonla buL any lung lnfecLlon can worsen sympLoms and speed deLerloraLlon of lung funcLlon
AnLlbloLlcs are usually called for when acuLe bronchlLls or pneumonla occurs and Lhe paLlenL has slgns
of bacLerlal lnfecLlon such as green or yellow spuLum
1he mosL common organlsms causlng pneumonla or exacerbaLlons ln people wlLh CCu lnclude
5tteptococcos poeomooloe noemopllos lofloeozoe and Moxotello cotottolls 1he cholce of anLlbloLlc
depends on Lhe bacLerla belng LreaLed and Lhe local raLe of bacLerlal reslsLance Lo common anLlbloLlcs
revenLlve anLlbloLlc Lherapy for paLlenLs wlLh frequenL exacerbaLlons ls dlscouraged slnce Lhls pracLlce
conLrlbuLes Lo Lhe developmenL of bacLerlal reslsLance
Ant|b|ot|c Cpt|ons
8eLaLacLams
8eLalacLam anLlbloLlcs lnclude penlcllllns cephalosporlns and some newer medlcaLlons 1hey share
common chemlcal feaLures and all lnLerfere wlLh bacLerlal cell walls
leolcllllos enlclllln was Lhe flrsL anLlbloLlc Many forms of Lhls sLllllmporLanL drug are avallable Loday
O enlclllln derlvaLlves called amlnopenlcllllns parLlcularly amoxlclllln (Amoxll olymox 1rlmox
Wymox or any generlc formulaLlon) are now Lhe mosL common penlcllllns used Amoxlclllln ls
lnexpenslve and aL one Llme was hlghly effecLlve agalnsL 5 poeomooloe unforLunaLely
bacLerlal reslsLance Lo amoxlclllln has lncreased slgnlflcanLly boLh among 5 poeomooloe and n
lofloeozoe Amplclllln ls slmllar buL requlres more doses and has more severe gasLrolnLesLlnal
slde effecLs Lhan amoxlclllln
O AmoxlcllllnclavulanaLe (AugmenLln) ls known as an augmenLed penlclllln LhaL works agalnsL a
wlde specLrum of bacLerla and ls used for more severe exacerbaLlons An exLended release form
ls also avallable
Many people have a hlsLory of allerglc reacLlon Lo penlclllln buL some evldence suggesLs Lhe allergy may
noL reLurn ln a slgnlflcanL number of adulLs Skln LesLs are avallable Lo help deLermlne wheLher someone
wlLh a hlsLory of penlclllln allergles could LoleraLe Lhese lmporLanL anLlbloLlcs
epolospotlos MosL of Lhese agenLs are noL very effecLlve agalnsL bacLerla LhaL have developed
reslsLance Lo penlclllln and are used for more severe exacerbaLlons 1hey are classlfled accordlng Lo
Lhelr generaLlon
O Second generaLlon cefaclor (Ceclor) cefuroxlme (CefLln) cefprozll (Cefzll) and loracarbef
(Lorabld)
O 1hlrd generaLlon cefpodoxlme (vanLln) cefdlnlr (Cmnlcef) cefdlLoren (SpecLracef) ceflxlme
(Suprax) and cefLlbuLen (Cedex) CefLrlaxone (8ocephln) ls an ln[ecLed cephalosporln 1hese
anLlbloLlcs are effecLlve agalnsL a wlde range of CramnegaLlve bacLerla CefdlLoren has also
been shown Lo be 83 effecLlve agalnsL noemopllos lofloeozoe and 90 effecLlve agalnsL
penlcllllnreslsLanL sLralns of 5 poeomooloe
lluoroqulnolones (Culnolones)
lluoroqulnolones (qulnolones) lnLerfere wlLh Lhe bacLerlas geneLlc maLerlal Lo prevenL Lhem from
reproduclng 1hese anLlbloLlcs are used for more severe exacerbaLlons
O 8esplraLory qulnolones are currenLly Lhe mosL effecLlve drugs avallable agalnsL a wlde range of
bacLerla 1hese drugs lnclude levofloxacln (Levaquln) sparfloxacln (Zagam) and gemlfloxacln
(lacLlve) Levofloxacln was Lhe flrsL drug approved speclflcally for penlcllllnreslsLanL 5
poeomooloe Some of Lhe newer fluoroqulnolones need Lo be Laken only once a day
O 1he fourLhgeneraLlon qulnolones moxlfloxacln (Avelox) and cllnafloxacln (whlch ls sLlll under
developmenL) are provlng effecLlve agalnsL anaeroblc bacLerla
5 poeomooloe sLralns reslsLanL Lo Lhe resplraLory qulnolones are uncommon ln Lhe uS buL reslsLance
ls dramaLlcally lncreaslng
Many qulnolones cause slde effecLs lncludlng senslLlvlLy Lo llghL and neurologlc psychlaLrlc and hearL
problems regnanL women should noL Lake Lhls class of drugs Culnolones also enhance Lhe poLency of
oral anLlcloLLlng drugs
When lL comes Lo LreaLlng acuLe exacerbaLlons of chronlc bronchlLls socalled secondllne anLlbloLlcs
amoxlclllln clavulanaLe (AugmenLln) macrolldes second or LhlrdgeneraLlon cephalosporlnes and
qulnolones appear Lo be more effecLlve Lhan and [usL as safe as flrsLgeneraLlon anLlbloLlcs
(amplclllln doxycycllne and LrlmeLhoprlm/sulfameLhoxazole)
Macrolldes Azalldes and keLolldes
Macrolldes and azalldes also affecL Lhe geneLlcs of bacLerla 1hese drugs lnclude
O AzlLhromycln (ZlLhromax Zmax)
O ClarlLhromycln (8laxln)
O LryLhromycln
O 8oxlLhromycln (8ulld)
1hese anLlbloLlcs are effecLlve agalnsL aLyplcal bacLerla such as mycoplasma and chlamydla All buL
eryLhromycln are effecLlve agalnsL n lofloeozoe 1hey are also used ln some cases for 5 poeomooloe
and M cotottolls buL Lhere ls lncreaslng bacLerlal reslsLance Lo Lhese medlclnes Macrollde reslsLance
raLes doubled beLween 1993 1999 as more and more chlldren were belng LreaLed wlLh Lhese
anLlbloLlcs Some research suggesLs Lhese agenLs may reduce Lhe rlsk of a flrsL hearL aLLack ln some
paLlenLs by reduclng lnflammaLlon ln Lhe blood vessels
ketollJes keLolldes are a new class of anLlbloLlcs 1hey are derlved from eryLhromycln and were
developed Lo combaL organlsms LhaL have become reslsLanL Lo macrolldes 1ellLhromycln (keLek) Lhe
flrsL anLlbloLlc ln Lhe keLollde class was approved by Lhe luA ln 2004 for Lhe LreaLmenL of CA acuLe
bacLerlal exacerbaLlons of chronlc bronchlLls and acuLe slnuslLls Powever ln lebruary 2007 Lhe luA
wlLhdrew approval of keLek for acuLe bacLerlal slnuslLls 1he agency declded LhaL Lhe serlous rlsks of
keLek ouLwelghed lLs beneflLs for slnuslLls LreaLmenL 1he declslon followed several 2006 reporLs of
deaLhs from severe llver damage 1ellLhromycln ls approved only for Lhe LreaLmenL of CA 1he drug
carrles a sLrong black box warnlng noLlng lLs poLenLlally serlous or deadly slde effecLs lncludlng llver
fallure vlslon problems loss of consclousness and neuromuscular problems
1eLracycllnes
1eLracycllnes lnhlblL bacLerlal growLh 1hey lnclude doxycycllne LeLracycllne and mlnocycllne 1hey can
be effecLlve agalnsL 5 poeomooloe and M cotottolls buL bacLerla LhaL are reslsLanL Lo penlclllln are
also ofLen reslsLanL Lo doxycycllne 1he slde effecLs of LeLracycllnes lnclude skln reacLlons Lo sunllghL
burnlng ln Lhe LhroaL and LooLh dlscoloraLlon
1rlmeLhoprlmSulfameLhoxazole
1rlmeLhoprlmsulfameLhoxazole (such as 8acLrlm CoLrlm and SepLra) ls less expenslve Lhan amoxlclllln
and parLlcularly useful for adulLs wlLh mlld bacLerlal upper resplraLory lnfecLlons who are allerglc Lo
penlclllln 1he drug ls no longer effecLlve agalnsL cerLaln sLrepLococcal sLralns lL should noL be used ln
paLlenLs whose lnfecLlons occur afLer denLal work or ln people who are allerglc Lo sulfa drugs Allerglc
reacLlons can be very serlous
-DSI-G I-1LIL-1IC-S
MonlLorlng
MonlLor for adverse effecLs of bronchodllaLors Lremulousness Lachycardla cardlac
arrhyLhmlas cenLral nervous sysLem sLlmulaLlon hyperLenslon
MonlLor condlLlon afLer admlnlsLraLlon of aerosol bronchodllaLors Lo assess for lmproved
aeraLlon reduced advenLlLlous sounds reduced dyspnea
MonlLor serum Lheophylllne level as ordered Lo ensure LherapeuLlc level and prevenL LoxlclLy
MonlLor oxygen saLuraLlon aL resL and wlLh acLlvlLy
SupporLlve Care
LllmlnaLe all pulmonary lrrlLanLs parLlcularly clgareLLe smoke Smoklng cessaLlon usually
reduces pulmonary lrrlLaLlon spuLum producLlon and cough keep Lhe paLlenL's room as dusL
free as posslble
use posLural dralnage poslLlons Lo help clear secreLlons responslble for alrway obsLrucLlons
1each conLrolled coughlng
Lncourage hlgh level of fluld lnLake ( 8 Lo 10 glasses 2 Lo 23 llLers dally) wlLhln level of cardlac
reserve
Clve lnhalaLlons of nebullzed sallne Lo humldlfy bronchlal Lree and llquefy spuLum Add molsLure
(humldlfler vaporlzer) Lo lndoor alr
Avold dalry producLs lf Lhese lncreases spuLum producLlon
Lncourage Lhe paLlenL Lo assume comforLable poslLlon Lo decrease dyspnea
lnsLrucL and supervlse paLlenL's breaLhlng reLralnlng exerclses
use pursed llp breaLhlng aL lnLervals and durlng perlods of dyspnea Lo conLrol raLe and depLh of
resplraLlon and lmprove resplraLory muscle coordlnaLlon
ulscuss and demonsLraLe relaxaLlon exerclses Lo reduce sLress Lenslon and anxleLy
MalnLaln Lhe paLlenL's nuLrlLlonal sLaLus
8eemphaslze Lhe lmporLance of graded exerclse and physlcal condlLlonlng programs
Lncourage use of porLable oxygen sysLem for ambulaLlon for paLlenLs wlLh hypoxemla and
marked dlsablllLy
1raln Lhe paLlenL ln energy conservaLlon Lechnlque
Assess Lhe paLlenL for reacLlvebehavlors such as anger depresslon and accepLance
hLLp//healLhnyLlmescom/healLh/guldes/dlsease/chronlcobsLrucLlvepulmonary
dlsease/medlcaLlonshLml