TALE 18: COPD TREATMENT
Welcome everyone to the opportunity of the basics of pharmacology in this video we’re gonna talk about the treatment strategies used in the treatment of the copd that is chronic obstructive pulmonary disease so what are the different treatment objectives the treatment objectives endorsed by the goals include the following so the goals guideline is being followed
During the treatment of the copd so it includes prevent the disease progression so one way is by the smoking cessation so if you remember in our introduction video of copd we had mentioned the smoking is one of the primary causal factor for causing or development of the copd so prevent the disease progression then relieve symptoms and imbrue exercise sauron’s
That is to enable the patient to perform the normal daily activities then improve the health status prevent and treat excess herbacious prevent entry the complications and finally to reduce from mortality so when you talk about the pharmacological treatment how is it happening so therapy is usually based on the disease staging which is usually determined by
The spirometry so one for this is staging is done then we initiate the drug therapy so short-acting anticholinergics and beta agonist alone or in combination are the most commonly used initial agents long-acting bronchodilators such as sal metro for metro tiotropium and theophylline are added to the short acting agents methos anthems are usually added when
The response to other agencies inadequate along with the bronchodilation these agents will increase the exercise capacity increase the quality of life degrees the desire and degrees the frequency and severity of the excess elevations especially the tight-roping a new agent was recently approved that is rope limb last which is a selective pde for inhibitor
That this indicator to decrease the copd exacerbation in certain patients bronchodilators are the most important therapy for symptoms in copd inhaled corticosteroids such as the fluticasone and villainous i’d have shown small benefits in fev1 the majority of that benefit occurs in reducing the severity of excessive ations and not the number of the excessive
Asians first we’re going to talk about de colon objects such as the ipratropium bromide tiotropium bromide and atropine so these anticholinergics may be used as first-line bronchodilators or in conjunction with the beta agonist and treatment of copd because these agents are the most potent bronchodilators for this condition so how does these and ecologist act
So they are mainly responsible for producing bronchodilation by competitively inhibiting the cholinergic responses so how does this happen so what is the usual cholinergic response so usually what happens is that kolodziejczak response acting on the lungs is particularly increasing the bromo constriction and mucus secretion but when these anticholinergics are
Administered cause the inhibition of the cholinergic responses thereby inhibits the– or reduces the praga constriction mucus secretion thereby cause the bronchodilation the ipratropium entire opium bromide additionally has got an effect by decreasing the sputum volume without altering the viscosity some studies have shown an increased response to these agents in
Copd when they’re combined with the beta agonist tai chi opium has greater affinity for cholinergic receptors than the retro pip now how is this administer so a pro tropen bromide is about three to five times more potent and has significantly fewer side effects than the atropine which is rarely used today since the development of cannibalized approach opium the
Initial metered dose inhaler dosing of the approach opium bromide is to inhalations that is 40 micro gram four times daily but dosing can be increased to six inhale missions four times daily without significant risk these higher doses are often require to achieve therapeutic benefit administration should be why are the major dose inhaler with spacer or major
Dose inhaler alone using a closed mouth technique dosing of a prayer opium bromide solution is 500 microgram per 2.5 ml that is one unit dose vial or more via the nebulizer four times daily coming to the tight-roping bromide capsules which contain about 22.5 microgram tiotropium bromide monohydrate which is equivalent to 18 microgram thai opium tiotropium is an
Inhalation powder contained in a heart capsule it should be administered once daily only via a handihaler device which delivers 10 microgram tiotropium patient should generally not be placed on both the petropia and tightrope him because of the increased risk of anticholinergic side effects and no additional bronchodilation is slightly achieved by adding the
Appropiate for instance if our copd patient is currently on a platter opium and albert schroer combination and try to rope him is starter then the albert role should be continued as a short-acting bronchodilators and the approach opium should be discontinued next we are talking about the beta agonist and these are very useful as first-line bronchodilators are
Used in conjunction with the anticholinergic agents in the maintenance treatment of copd short-acting agents are used regularly or on an as-needed basis for symptoms some patients may respond clinically to the prolonged treatment with the beta-2 agonist even after demonstrating lack of acute reversibility to short-acting agents so these beta agonist will act on
The smooth muscles of the lungs and thereby causing the dilation of the bronchial passages and at the same time it relieves the disney ëcause by airway obstruction although the response is usually not as significant s&p with asthma these agents may also increase the mucociliary clearance by stimulating the ciliary activity and thereby helping the patients
To expectorate disputer the beta 2 agonist are administered via inhalation can be ripe out the inhalers or the nebulizers the meter those inhalers with or without us face up unless the patient cannot use the drug properly then an oral agent is used cautiously beta-2 agonist of the same duration should not be used in combination because in adequate dose of the
Single agent provides a peak bronchodilation however it is reasonable to administer a long-acting product such as these salma troll or forma troll on a regular basis with a short-acting agent reserved for as needed or rescue therapy salma troll for metal i for metro are basically the long-acting beta agonist that are administered twice daily in that tirol
Is a recently marketed long-acting beta agonist that does edmonson once daily as a dry powder inhaler they may also be used in combination with a petropia bromide or tiotropium neither agent is used on an as-needed basis for rescue therapy although former soldiers have a rapid onset of action inhaler devices that require rapid inspiratory rate may result in
Sub optimal length deposition in the copd patient with limited inspiratory capacity a metered dose inhaler or the nebulizer may be more optimal in this type of patient next is theophylline the offal compounds typically are added to the drug regiment after an unsuccessful trial of approach opium bromide and beta adrenergic s– the theophylline appears to have a
Greater clinical role in copd than in asthma other similar agents it is phosphodiesterase inhibitors are in development you feel and basically inhibits the pde enzyme and are responsible for increasing the mucociliary clearance stimuli respiratory drive enhancer diaphragmatic contractility umbro the ventricular ejection fraction and stimulate the renal diuresis
There bronchodilator properties are modest at best beautiful and may be used in lieu of other long-acting bronchodilators or in combination a trial of one to two months with the serum drug level maintain and fight it 12 microgram per ml is usually done and then based on that it is maximized because of the non bronchodilator effects of the mean dial sandals they
May be continued in the face of a clinical response even in the absence of in brut s eb1 if no change occurs in the patient’s clinical condition and are fev1 then theophylline therapy should be discontinued owing to the potential for side effects so what are the basic precautions and monitoring effects in case of theophylline administration serum drug level
Should be closely monitored in all the patients especially those with signs of toxicity such as the tachycardia or nausea vomiting as well as in patients with liver impairment congestive heart failure at our core pulmonale as a result of reduced theophylline metabolism potential drug interactions such as with the you supra frogs axon may warn the blood testing
Next is the row from last which is indicated as a treatment to reduce the risk of copd exacerbation in patients with severe copd associated with chronic bronchitis so it is basically a long-acting selective pde 4 inhibitor that provides the anti-inflammatory effects and mild bronchodilator effects the dose of pro forma last is 500 microgram once daily with or
Without food the primary side effects of the drug are gi intolerance such as the diarrhea nausea and even weight loss averaging of at five pounds were seen in the clinical trials drug interactions through the cy p450 may occur and allow goes to those seen with you phillip next we’re talking about the corticosteroids so there systemic corticosteroids as well as
Inhaled corticosteroids systemic corticosteroids that is preferably oral are indicated in the treatment of acute copd exacerbation and chronically in some severe patients in here corticosteroids play a less important role in copd ban and asthma candidates for prolonged use of inhaled corticosteroid therapy should be symptomatic and have a documented spiro metric
Response have and should also have an fev1 less than 50% predicted with the history of repeated accelerations requiring systemic corticosteroids or antibiotics long-term use of systemic steroids should be avoided if possible osteoporosis of the spine and ribs is especially common in copd patients receiving frequent or maintenance system extorts it has been recently
Recognized that in his droids increase the risk of bacterial pneumonia in copd patients how do you administer dose for oral use in outpatient management of acute exacerbations prednisone or prednisolone is an min stood at a dosage of 14 milligram per day for 10 days the dose of oral at a spender salon or intravenous corticosteroids such as methylprednisolone for
Hospital management of the acute copd exacerbations are you not yet established however the doses and duration therapy should be limited that is for example 30 to 40 milligram per day of prenda so on for 10 to 14 days in order to avoid the significant adverse effects in copd inhaled steroids are not as efficacious as in asthma patients in appropriate patients
The corticosteroids may be administered by a dp ir mdi with special response to the oral corticosteroids does not predict response to inhaled corticosteroids medium doses of inhaled corticosteroids are recommended for copd inhaler device that require rapid respiratory rate are generally not desirable in copd patients next we are talking about antibiotics these
Antibiotics are actually you should feed the excess or patients with suspected infection as evidenced by an increase in volume or change in color or viscosity of the sputum along with the disney a– prevention of infection with chronic antibiotic therapy is controversial and should be considered only in patients with multiple accelerations annually that is about
More than two per year so how was it therapy with the antibiotics ambulatory antibiotic therapy of excessive asians and patients with copd is recommended when there is evidence of worsening thus nia and cost the purulent sputum and increase sputum volume hospital or abort she antibiogram should be reviewed when selecting an appropriate agent for this septic or
Ghazni mooney or the n catalyst and h influencing agents may include either a second generation cephalosporin example the sea frog symes mcclure or trimethoprim sulfamethoxazole or beta lactam with or without a beta-lactamase inhibitor macrolides or an oral fluoroquinolone levofloxacin ciprofloxacin can be added note that the recent evidence indicates chronic
Macrolides may have a role to degree copd exacerbation if the infection with the m pneumonia or legend alone nemo philia is a concern although uncommon copd flares or macro light or fluoroquinolone may be added and by the treatment of pneumonia in hospitalized patients with copd includes either a second or third-generation cephalosporin such as the cefuroxime
Ceftriaxone sifu toxin or a beta lactam with or without a beta-lactamase inhibitor then pepra santosha bottom a macro light or a fluoroquinolone copd exacerbation sar treated for three to ten days bending on the asian used and the patient for instance the moxifloxacin 400mg is used for five days next drug that can be used as the mucolytics such as the oral enesta
System that may improve the sputum clearance and disrupt the mucus plugs the next pictorial such as graph enison may be used and potassium iodide should be avoided because of side effects associated with the identidad beam then antioxidants such as similar to the oral nf stem system can be used which reduces the excess herbaceous frequency then influenza virus
Vaccine can be recommended because of its ability to reduce the death and serious illness by almost 50% so that is all about the different treatment strategies used in the treatment of the copd so let’s just summarize so in this video we have discussed about the treatment goal that has been endorsed by the gold guidelines then the different classes of drugs which
Includes the anticholinergics beta ganas theophylline rough lama last corticosteroids antibiotics mucolytics expectorants and the oxidants influenza virus vaccine and i hope you have clearly understood regarding the pharmacological treatment aspect of the copd and if there’s any doubt concern or any comments and suggestions please do mailing us
Transcribed from video
COPD TREATMENT By Apothecary Tales
