Chronic obstructive pulmonary disease severity

Chodosh S, Flanders JS, Kesten S, Serby CW, Hochrainer D, Witek TJ Jr. Effective delivery of particles with the HandiHaler dry powder inhalation system over a range of chronic obstructive pulmonary disease severity. J Aerosol Med 2001 14(3) 309-15. 

A 67-year-old man with a history of chronic obstructive pulmonary disease presents to the emergency department with high fevers, shaking chills, severe chest pain, and shortness of breath. His family members state that he has been confused all day. He started having a severe cough 2 days ago, with excessive sputum production. He received doxycycline 100 mg twice daily for an upper respiratory tract infection 7 days ago. 

The AEGL-1 concentration was based on a 1-hour (h) no-effect concentration of 8,000 parts per million (ppm) in healthy human subjects (Emmen et al. 2000). This concentration was without effects on pulmonary function, respiratory parameters, the eyes (irritation), or the cardiovascular system. Because this concentration is considerably below that causing any adverse effect in animal studies, an intraspecies uncertainty factor (UF) of 1 was applied. The intraspecies UF of 1 is supported by the absence of adverse effects in therapy tests with patients with severe chronic obstructive pulmonary disease and adult and pediatric asthmatics who were tested with metered-dose inhalers containing HFC-134a as the propellant. Because blood concentrations in this study approached equilibrium following 55 minutes (min) of exposure and effects are determined by blood concentrations, the value of 8,000 ppm was made equivalent across all time periods. The AEGL-1 of 8,000 ppm is supported by the absence of adverse effects in experimental animals that inhaled considerably higher concentrations. No adverse effects were observed in rats exposed at 81,000 ppm for 4 h (Silber and Kennedy 1979) or in rats exposed... 

Q66 Hypnotic doses of diazepam may cause hyperventilation in patients with severe chronic obstructive pulmonary disease. Diazepam causes central nervous system depression. 

Prakash O, Kumar R, Rahman M, Gaur SN. (2006) The clinico-physiological effect of inhaled tiotropium bromide and inhaled ipratropium bromide in severe chronic obstructive pulmonary disease. Ind J Allergy Asthma Immunol 20 105-111 For further information http //www.rxlist.com/spiriva-drug.htm (accessed on 24.12.2010). 

Iloprost has not been evaluated in patients with chronic obstructive pulmonary disease (CORD), severe asthma, or acute pulmonary infections. 

Propranolol, nadolol, timolol, penbutolol, carteolol, sotalol, and pindolol Bronchial asthma or bronchospasm, including severe chronic obstructive pulmonary disease. Metoprolol Treatment of Ml in patients with a heart rate less than 45 beats/min significant heart block greater than first degree (PR interval 0.24 seconds or more) systolic blood pressure less than 100 mm Hg moderate to severe cardiac failure. Sotalol Congenital or acquired long QT syndromes. 

Injection - To relieve respiratory distress in bronchial asthma or during acute asthma attacks and for reversible bronchospasm in patients with chronic bronchitis, emphysema, and other obstructive pulmonary diseases severe acute anaphylactic reactions, including anaphylactic shock and cardiac arrest to restore cardiac rhythm. 

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. 

Bronchial asthma, a history of bronchial asthma, or severe chronic obstructive pulmonary disease sinus bradycardia second- and third-degree AV block overt cardiac failure cardiogenic shock hypersensitivity to any component of the products. 

Contraindication are myasthenia gravis, chronic obstructive pulmonary disease and severe hepatic disease. Both in the elderly and in children paradoxical reactions were described. In the elderly the use of benzodiazepines is strongly correlated with falls and hip fractures. 

Unlabeled Uses Bronchial asthma, chronic obstructive pulmonary disease (COPD), cardiogenic shock, overt cardiac failure, second or third degree AV block, severe sinus bradycardia... 

Ramelteon is available in 8-mg tablets for oral administration. The current maximum dosage is 8 mg administered at night however, during trials, up to 16 mg was studied. Ramelteon should be used with caution in elderly patients because plasma levels were twice those in healthy adults in clinical trials. Ramelteon should not be used by patients with severe hepatic impairment. This medication has been evaluated in moderate sleep apnea and chronic obstructive pulmonary disease and appeared to be safe to administer in this population. Ramelteon was not studied in subjects with severe sleep... 

Albuterol Selective B2 agonist Prompt, efficacious bronchodilation Asthma, chronic obstructive pulmonary disease (COPD) drug of choice in acute asthmatic bronchospasm Aerosol inhalation duration several hours also available for nebulizer and parenteral use Toxicity. Tremor, tachycardia t overdose arrhythmias... 

A 60-year-old man with a history of moderate chronic obstructive pulmonary disease presents in the emergency department with a broken hip suffered in an automobile accident. He complains of severe pain. What is the most appropriate immediate treatment for his pain Are any special precautions needed ... 

However, in individuals with increased intracranial pressure, asthma, chronic obstructive pulmonary disease, or cor pulmonale, this decrease in respiratory function may not be tolerated. Opioid-induced respiratory depression remains one of the most difficult clinical challenges in the treatment of severe pain. Research is ongoing to understand and develop analgesic agents and adjuncts that avoid this effect. Research to overcome this problem is focused on 5 receptor pharmacology and serotonin signaling pathways in the brainstem respiratory control centers. 

Nonselective beta blockers affect beta-2 receptors on the lungs as well as beta-1 receptors on the heart, and these nonselective agents can increase bronchocon-striction in patients with asthma and chronic obstructive pulmonary disease. Hence, a drug that is more specific for beta-1 receptors is preferred in these patients. Beta blockers can also produce excessive slowing of cardiac conduction in some patients, resulting in an increase in arrhythmias. Severe adverse reactions are rare, however, and beta blockers are well-tolerated by most patients when used appropriately to treat arrhythmias. 

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. 

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. 

Cachexia is loss of weight, muscle atrophy, fatigue, weakness and significant loss of appetite. It is seen in patients with cancer, acquired immunodeficiency syndrome (AIDS), chronic obstructive pulmonary disease and congestive heart failure. Underlying causes are poorly understood, but there is an involvement of inflammatory cytokines, such as TNF-a, IFN-y, IL-6 and tumour-secreted proteolysis-inducing factor. Related syndromes are kwashiorkor and marasmus, although these are most often symptomatic of severe malnutrition. 

Bronchial asthma or chronic obstructive pulmonary disease Cardiogenic shock Hypersensitivity to propranolol Overt cardiac failure Second and third degree AV block Severe sinus bradycardia... 

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