chronic obstructive pulmonary disease Flashcards
COPD definition
“heterogenous lung condition characterized by chronic respiratory symptoms (dyspnea, cough, sputum production, exacerbations) due to abnormalities of the airways (bronchitis, bronchiectasis) and/or alveoli (emphysema) that cause persistent, often progressive, airflow obstruction”
management of COPD
The Global Initiative for Chronic Obstructive Lung Disease (GOLD) has published comprehensive guidelines for the management of COPD
Grading based on severity of the airflow obstruction
- GOLD 1 (mild) to GOLD 4 (very severe)
pathophysiology of COPD
In patients with COPD, there appears to be an amplified inflammatory response to airway irritants
- Increased numbers of macrophages, neutrophils, and lymphocytes release mediators that draw inflammatory cells from the vasculature and induce structural changes
The inflammation leads to airflow obstruction and gas trapping
- Airflow resistance is increased in the small airways and lung parenchyma can lose elastic recoil leads to hyperinflation and reduce ability to empty the lungs
goals of treatment for COPD
slow the disease process and maintain quality of life
rational drug selection group A COPD
Few exacerbations and mild symptoms
- Drug of choice: a single long-acting bronchodilator agent
rational drug selection group B COPD
More symptomatic, but still not having frequent or severe exacerbations
- The combination of two long-acting bronchodilators is recommended
rational drug selection group E COPD
All patients who have frequent or severe exacerbations
- Combination of two long-acting bronchodilators and possible addition of an ICS are recommended
three types of bronchodilators used in COPD management
- B2 agonists
- muscarinic agents
- methylxanthines
B2 agonists in COPD
Mainstay of COPD therapy
- Regular use of SABA are no longer recommended
LABAs are preferred for routine bronchodilator therapy
- Provides longer bronchodilator effects
- Helps to prevent symptom breakthrough as the SABA effect wears off after a few hours
muscarinic agents for COPD
SAMA are no longer first-line therapy for most COPD pts
LAMAs have become a key player in COPD management
- Work by binding to M3 muscarinic receptors, blocking the effects of acetylcholine on the airway smooth muscle
- Results in bronchodilation
the preferred choice for initiating therapy for most patients with COPD
both a LABA and a LAMA
results in:
- improved lung function
- decreased dyspnea
- reduced rates of exacerbations
corticosteroids in COPD
Have nonspecific anti-inflammatory activity at multiple points in the inflammatory process
- Effects of these meds are less dramatic in COPD than those seen in asthma
In patients who have frequent or severe exacerbations, the addition of an ICS to LABA/LAMA therapy can be beneficial
two triple therapy products for COPD
ICS/LABA/LAMA
- breztri
- trelegy
oral corticosteroids in COPD
may be useful in the short-term tx of acute COPD exacerbations
