Chronic Airway Disease Flashcards
Order of therapy for COPD
Smoking cessation/exercise/self-management/education and short acting bronchodilators –> Long acting bronchodilators –> Pulmonary rehabilitation –> Inhaled corticosteroids/LABA –> oxygen –> surgery
Cannabis for COPD
Thought to be a bronchodilator
No change in dyspnea
No change in respiratory physiology
Cannabis for normal resp physiology
Increases cough, sputum, wheeze
Increase FVC
Bronchodilator
Immunosuppression of alveolar macrophages
2 ways all docs can be involved with palliative care
Symptom management
Advanced care planning
How can short acting opioids be helpful in advanced COPD
In low doses, can act as mild bronchodilators, increase blood supply to the heart, and reduce feeling of panic from having SOB
Allows you to breathe deeper and slower
Not for early or moderate COPD (only really advanced)
MPOWER (6 interventions to reverse tobacco epidemic)
M: monitor tobacco use and prevention policies
P: protect people from soke
O: offer to help quit
W: warn about the dangers
E: enforce bans on advertising, promotion, and sponsorship
R: raise taxes
This is implementing the WHO FCTC (framework convention for tobacco control) demand reduction measures
Where does nicotine bind in the brain?
nACH receptors in the VTA primarily
Results in a release of dopamine in the nucleus accumbens (linked to reward)
What are the 2 evidence based methods of treatment for tobacco addiction?
Counselling
Medications
Medications for quitting smoking
Nicotine replacement therapy
Buproprion
Varenicline
Buproprion
Antidepressant used to quit smoking
Doubles the likelihood of cessation
Varenicline
Nicotinic acetylcholine receptor partial agonist
Triples likelihood of cessation
Why is the nicotine patch not addictive?
Releases nicotine slowly and constantly
Keeps constant levels in the blood
Doesn’t go to brain very fast
What factor is the strongest predictor of all-cause mortality in patients with COPD?
Physical activity!
More activity = more survival
Goal of pulmonary rehabilitation
Improve physical functioning and quality of life
Using a combo of exercise, education, and behavioural therapy interventions
