Chronic obstructive pulmonary disease airway obstruction

Sympathomimetics (drugs that mimic the sympathetic nervous system) are used primarily to treat reversible airway obstruction caused by bronchospasm associated with acute and chronic bronchial asthma, exercise-induced bronchospasm, bronchitis, emphysema, bronchiectasis (abnormal condition of the bronchial tree), or other obstructive pulmonary diseases. 

Pulmonary disease is characterized by thick mucus secretions, impaired mucus clearance, chronic airway infection and colonization, obstruction, and an exaggerated neutrophil-dominated inflammatory response. 

Administer oxygen, usually 8-10 L/min however, lower concentrations may be appropriate for patients with chronic obstructive pulmonary disease. Maintain airway with oropharyngeal airway device. 

Aerosolised medicines have been used for centuries to treat respiratory diseases, with inhalation therapy for the airways focused primarily on the treatment of asthma and chronic obstructive pulmonary disease (COPD). The development of new products for delivery to the lungs for these respiratory diseases includes new steroids and beta agonists plus combination products featuring both agents. New classes of anti-asthma medication are also being developed for inhalation with the aim of delivering them directly to the inflamed airways. 

The first commercially available DPI system appeared on the market in 1949, developed and marketed by Abbott under the name Aerohaler. Like all early pulmonary drug-delivery devices, it delivered small-molecule compoimds (bronchodilators or inhaled corticosteroids) to the airways (not necessarily the deep limg) for the treatment of asthma or chronic obstructive pulmonary disease. Table 6 lists some of the early DPI systems used for asthma and COPD the energy somces in these devices were mechanical and patient inspiration. 

The TP receptor requires the G/G protein to activate the Src-Ras-ERKl/2 (extracellular signal-regulated kinase 1 and 2) cascade to induce the proliferative response, which in turn promotes the rapid nuclear translocation of activated ERKl/2 (201). Because TP receptor may be activated by many inflammatory mediators (202-204), these findings suggest new therapeutic strategies that alter the ASM hypertrophy or hyperplasia observed in the chronic airflow obstruction and airway inflammation that characterizes asthma, chronic bronchitis, bronchiolitis obliterans, and chronic obstructive pulmonary disease. 

COPD is a progressive obstruction of the airways as a consequence of small airway disease and emphysema.It is the fourth leading cause of death in developed countries. Chronic inflammation and regulated air supply in the airway are amplified in case of COPD. Decreased activity of histone deacetylase is observed in chronic obstructive pulmonary disease. ... 

Particulate matter air pollution is especially harmful to people with lung disease such as asthma and chronic obstructive pulmonary disease (COPD), which includes chronic bronchitis and emphysema, as well as people with heart disease. Exposure to particulate air pollution can trigger asthma attacks and cause wheezing, coughing, and respiratory irritation in individuals with sensitive airways. It was estimated in one major study that the excess risk of total mortality is 6.2% per each increase in 10pgPM2.s/m and 9.3% for cardiopulmonary mortality. ... 

Multiple episodes of PTFE-induced inhalation fever over an 18-month period were associated with marked progression of chronic obstructive pulmonary disease in a carding machine operator. Permanent airway damage may occur in some individuals after repeated instances of polymer fume fever. 

Pharmacology The methyixanthines (theophylline, its soluble salts and derivatives) directly relax the smooth muscle of the bronchi and pulmonary blood vessels, stimulate the CNS, induce diuresis, increase gastric acid secretion, reduce lower esophageal sphincter pressure, and inhibit uterine contractions. Theophylline is also a central respiratory stimulant. Aminophylline has a potent effect on diaphragmatic contractility in healthy people and may then be capable of reducing fatigability and thereby improve contractility in patients with chronic obstructive airways disease. Pharmacokinetics ... 

Epidural/Intrathecal administration Limit epidural or intrathecal administration of preservative-free morphine and sufentanil to the lumbar area. Intrathecal use has been associated with a higher incidence of respiratory depression than epidural use. Asthma and other respiratory conditions The use of bisulfites is contraindicated in asthmatic patients. Bisulfites and morphine may potentiate each other, preventing use by causing severe adverse reactions. Use with extreme caution in patients having an acute asthmatic attack, bronchial asthma, chronic obstructive pulmonary disease or cor pulmonale, a substantially decreased respiratory reserve, and preexisting respiratory depression, hypoxia, or hypercapnia. Even usual therapeutic doses of narcotics may decrease respiratory drive while simultaneously increasing airway resistance to the point of apnea. Reserve use for those whose conditions require endotracheal intubation and respiratory support or control of ventilation. In these patients, consider alternative nonopioid analgesics, and employ only under careful medical supervision at the lowest effective dose. 

Pulmonary disease Pilocarpine has been reported to increase airway resistance, bronchial smooth muscle tone, and bronchial secretions. Administer with caution and under close medical supervision in patients with controlled asthma, chronic bronchitis, or chronic obstructive pulmonary disease. 

Zanamivir is not recommended for treatment of patients with underlying airways disease such as asthma or chronic obstructive pulmonary disease (CORD) (see Warnings). 

Carboxyhemoglobinaemia Chronic obstructive airways disease Pulmonary hypoventilation syndrome Right-to-left cardiac shunt Absolute - physiologically inappropriate Ectopic erythropoietin production Renal carcinoma and cysts Hepatoma... 

The benefits of the use of (3-blockade appear to exceed by far the risks of bronchospasm in patients diagnosed with chronic obstructive pulmonary disease (COED) and/or suppression of hypoglycemic responses in diabetics. COPD is very different from bronchospas-tic asthma. Young people with asthma have highly reactive airways and can die within hours of a bronchospasm in response to an exposure to an external agent. This highly reversible dynamic condition contrasts sharply with the destruction of connective tissue in lung parenchyma and dead airway sacs that are not very reactive. This is a very different phenomenon. 

The principal use of theophylline is in the management of asthma. It is also used to treat the reversible component of airway obstruction associated with chronic obstructive pulmonary disease and to relieve dyspnea associated with pulmonary edema that develops from congestive heart failure. 

Oosterhoff Y, de long W, lansen MA, Koeter GH, Postma DS (1993) Airway responsiveness to adenosine 5 -monophosphate in chronic obstructive pulmonary disease is determined by smoking. Am Rev Respir Dis 147(3) 553-558... 

Adverse Effects. Oral administration of oseltamivir can cause gastrointestinal disturbances such as nausea, vomiting, diarrhea, and abdominal cramps. Zanamivir, which is administered by inhalation, is associated with bronchospasm and reduced opening of the airway. The adverse effects of zanamivir can be quite severe in people with bronconstrictive disease (asthma, chronic obstructive pulmonary disease), and this drug should probably be avoided in these individuals. 

Smoking leads to respiratory problems other than lung cancer. It causes chronic bronchitis, emphysema, and lower resistance to flu and pneumonia. It worsens asthma symptoms in adults and children. As these problems persist, chronic obstructive pulmonary disease (COPD, airway obstruction) develops. Eighty to 85% of deaths due to COPD are from smoking. The role of nicotine in chronic lung diseases such as COPD, emphysema, and asthma is uncertain. However it is known that nicotine can cause an enzyme to be released which is able to destroy parts of the lungs as is seen in emphysema. 

Molho M, Shulimzon T, Benzaray S, Katz I. Importance of inspiratory load in the assessment of severity of airways obstruction and its correlation with C02 retention in chronic obstructive pulmonary disease. Am Rev Respir Dis 1993 147(1) 45 19. 

Blockade of the 2 receptors in bronchial smooth muscle may lead to an increase in airway resistance, particularly in patients with asthma. Betai-receptor antagonists such as metoprolol or atenolol may have some advantage over nonselective antagonists when blockade of Bi receptors in the heart is desired and -receptor blockade is undesirable. However, no currently available i-selective antagonist is sufficiently specific to completely avoid interactions with 62 adrenoceptors. Consequently, these drugs should generally be avoided in patients with asthma. On the other hand, some patients with chronic obstructive pulmonary disease (COPD) may tolerate these drugs quite well. 

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