COPD treatment Flashcards
Name some pharmacological therapy for COPD
-bronchodilators
-corticosteroids
-oxygen
Name some non pharmacological therapy of COPD
-self care
-pulmonary rehabilitation
-surgery
-dietary
-NIV- usually BiPAP ( acute exacerbations
-end of life planning
Descibe what patients can do to help smoking cessation
-group therapy
-online support
-Nicotine replacement therapy (NRT)
-stop smoking medication
Describe NRT
-skin patches
-gum
-tablets, strips, losenges
-nasal/mouth spray
-e- cigarettes
Give some side effects of NRT
-skin irritation with patches
-irritation of nose, throat or eyes with nasal spray
-distrubed sleep
-upset stomach
-dizziness/headaches
Name some stop smoking medications
zyban- bupropion
-champix- vareicline
What are bronchodilators?
-relax smooth muscles around bronchioles
-maximise bronchodilation
-allow easier airflow
Two main groups used in COPD:
-Beta2 agonist - inhlaed
-antimuscarinics- inhaled
can be short or long acting
Why do we give bronchodilators if airway obstruction is irreversible?
bronchodilators help to reduce lung hyperinflation which improves resp muscle function and therfore better overal function
What does the bronchodilator anticholinergics do?
-atrovent ipratropium bromide
-spirivia (tiotropium)
-block parasympathetic maintenance of bronchial tone
-receptors precent in all airways but more prevelant in central airways
What does the bronchodilator Beta2 agonists do?
Ventolin- sambutamol
-relax airway smooth muscle
-receptors more prevelant in peripheral airway
What does it mean when Beta2 agonists and antichollenergic drugs act synergistically?
-act on different receptors
-act on different locations
-different modes of action
-combined effect on bronchodilator pathways
What are the effects of corticosteroids?
-used to reduce inflam in COPD (inhaled steroids alter genes within leukocyte nuclei and so damp down inflam)
-usually given in a combination with beta2 agonists or anticholenergic drugs
-reduced exacerbation rates
-improves health statue anad spiro
-but also has a greater risk of pneumonia
Name some combination inhalers
-steroid plus long acting beta2 agonist:
-symbicort, fostair, revlar
long acting beta 2 agonist plus long acting muscarinic antagonist:
-anoro
What is triple therapy in patients with COPD?
-combining LAMA, LABA and ICS
what does SABA stand for?
short acting B2 agonist
What does LABA stand for?
long acting B2 agonist
What does SAMA stand for?
short acting antimuscarinic agent
What does LAMA stand for?
long acting antimuscarinic agent
Name some other drug therapys for COPD
-antimicrobial- exacerbations and recurrent chest infections
-Mucolytics-reduce mucous production
-oxygen
-may increase QOL and excersise tolerance
-Beware of CO2 retention
-type II resp failure
-long term o2 therapy - min 15hrs a day
-treatment for anxiety and or depression
briefly describe the types of resp failure
type 1- lung failure
-gas exchange failure mainfested by hypoxaemia
type 2- pump failure
-ventilatory failure manifested by hypercapnia
Describe type 1 resp failure
-failure of oxygenation
-V/Q mismatch
-shunt
-diffusion impairment
-alveolar hypoventilation
Describe type 2 resp failure
-failure of ventilation
-failure of resp muscles, increased work of breathing or resp control
-increased production of CO2
-increased dead space
-shunt
Why does supplemental O2 cause CO2 retention?
-in healthy subjects increases in CO2 increases the drive to breath
-patients with COPD develop a reduced response to CO2 over time and so O2 levels are the main stimulus to breath ( hypoxic drive)
additional O2 reduces hypoxic drive and patients will hypoventilate
-This causes accumulation of CO2 in the blood and results in hypercapnia and results in respiratory acidosis
-PH od 6.8 or less is fatal
what is involved in pulmonary rehab?
-weekly group class with education and excersise
-excersise-increases muscle strength and fitness to reduce breathlessness
education- nutrition, living with COPD, finanical claim advice, COPD medication, treating exacerbations
Name some surgical treatments of COPD
-lung volume reduction surgery (LVRS)
-bullectomy
-lobectomy
-pneumonectomy
-transplant
What can be done to improve COPD management?
-accurate early diagnosis
-smoking cessation
-vaccinations
-inhaler technique
-functionality and symptom assessment
-improving self management skills
-education
-appropriate refferals( O2 assessment, pulmonary rehabilitation, nutrition)
