COPD Part 3 Flashcards
Pharmacotherapy
Pharmacotherapy
Bronchodilators
Corticosteroids
Others:
alpha1antitrypsin augmentation therapy, antibiotic agents, mucolytic agents, antitussive agents, vasodilators, and opioids
Vaccines:
influenza vaccines, Pneumococcal vaccination
grade I (mild) COPD
short-acting bronchodilator
grade II or III (moderate or severe)
short-acting bronchodilator and regular treatment with one or more long-acting bronchodilators
grade III or IV (severe or very severe) COPD
regular treatment with long-acting bronchodilators and/or inhaled corticosteroids (ICSs) for repeated exacerbations
are key for symptom management in stable COPD
Bronchodilator
are more convenient for patients to use, typically used for maintenance treatment for long-term symptom control
Long-acting bronchodilators
are usually used for acute management of symptomatic flairs.
Short-acting bronchodilators
relieve bronchospasm by improving expiratory flow through widening of the airways and promoting lung emptying with each breath.
Bronchodilator
These medications alter smooth muscle tone and reduce airway obstruction by allowing increased oxygen distribution throughout the lungs and improving alveolar ventilation
Bronchodilator
Bronchodilators can be delivered through
pressurized metered-dose inhaler (pMDI), a dry-powder inhaler (DPI), by a small-volume nebulizer (SVN), or via the oral route in pill or liquid form
are small handheld devices that may be carried in a pocket or purse
pMDIs and DPIs
is an excellent health care provider to consult on appropriate inhaler technique
respiratory therapist
Pressurized metered-dose inhalers (pMDIs) types
Conventional and breath-actuated
They are pressurized devices that contain aerosolized powder of medications.
pMDIs
may also be indicated to enhance deposition of the medication in the lung and help the patient coordinate activation of the pMDI with inspiration
spacer or valved-holding chambers
are designed so that they require coordination between the patient’s inspiration and the mechanics of the inhaler
pMDIs
rely solely on the patient’s inspiration for medication delivery, do not require the coordination necessary to administer pMDIs
dry-powder inhalers (DPIs)
is a handheld apparatus that is easier
to use than a pMDI or a DPI but lacks the convenience of these inhalers as it requires a power source in order to operate
small-volume nebulizer (SVN)
Common SVNs include
single-use pneumatic jet nebulizers with reservoir tubes
which are most commonly used in hospitals, and electronic nebulizers, which may be used in the home-based setting. are commonly prescribed when patients are challenged with being able to administer their medications through either a pMDI or a DPI
single-use pneumatic jet nebulizers with reservoir tubes
is a helpful technique to prepare for proper use of the SVN.
Diaphragmatic breathing
Several classes of bronchodilators are used that include
beta-adrenergic agonists, muscarinic antagonists (anticholinergics) and combination agents
Beta-adrenergic agonists include
short-acting beta-2-adrenergic agonists (SABAs) and
long-acting beta-2 adrenergic agonists (LABAs)
anticholinergic agents include
short-acting muscarinic antagonists (SAMAs) and
long-acting muscarinic antagonists (LAMAs)
may also be combined with bronchodilators. These medications may be used in combination to optimize bronchodilation
ICSs
have become the foundation for treating COPD. Combining these classes of medications in one inhaler has synergistic effects,
Fixed dose combinations of LABAs and LAMAs
are more convenient for patient use as compared to shortacting beta2-agonist bronchodilators
LABAs
is associated with less adverse reactions and promotes proper medication administration by avoiding the use of multiple inhaler devices
combination therapy
may improve the symptoms of COPD, they do not slow the decline in lung function
inhaled and systemic corticosteroids
Long-term treatment with oral corticosteroids is not recommended in COPD and can cause
steroid myopathy, leading to muscle weakness, decreased ability to function, and, in advanced disease, respiratory failure
may be prescribed for patients to determine whether pulmonary function improves and symptoms decrease
short trial course of oral corticosteroids
Treatment of COPD with combination of these in one inhaler may improve lung function
long-term beta2-agonists plus corticosteroids
Examples of long-term beta2-agonists plus corticosteroids
formoterol/budesonide, vilanterol/fluticasone furoate, and salmeterol/fluticasone.
reduces the incidence of community-acquired pneumonia in the general older adult population
Pneumococcal vaccination
can reduce serious illness and death in patients with COPD. It is recommended that people limit their risk
influenza vaccination and smoking cessation
is defined as an event in the natural course of the disease characterized by acute changes (worsening) in the patient’s respiratory symptoms beyond the normal day-to-day variations
exacerbation of COPD
Signs During an exacerbation
increased dyspnea that is a result of amplified hyperinflation and air trapping
Primary causes of an acute exacerbation are usually related to
viral infections, particularly human rhinovirus (i.e., the common cold)
bacterial infections and environmental factors
may be used as a treatment to reduce the risk of exacerbations in patients with severe COPD associated with chronic bronchitis and a history of exacerbations.
Roflumilast, selective phosphodiesterase-4 (PDE4) inhibitor
is first-line therapy and involves identifying the best medication or combinations of medications taken on a regular schedule
bronchodilator medications
Depending on the signs and symptoms these meds may also be used
corticosteroids, antibiotic agents, oxygen therapy, and intensive respiratory interventions
When the patient with an exacerbation of COPD arrives in an ED, the first
line of treatment is
supplemental oxygen therapy and rapid assessment to determine if the exacerbation is life-threatening
are recommended in the hospital management of a COPD exacerbation
Oral or intravenous (IV) corticosteroids, in addition to bronchodilators
may be used to assess response to treatment
short-acting inhaled bronchodilator
administration of antibiotics remains controversial, but in general, they should be administered when the patient has three cardinal symptoms of an exacerbation:
increase in dyspnea, increase in sputum volume, and sputum purulence
