Chronic obstructive pulmonary disease treatment

In a patient with chronic respiratory acidosis (e.g., chronic obstructive pulmonary disease), treatment is essentially similar to that for acute respiratory acidosis with a few important exceptions. Oxygen therapy should be initiated carefully and only if the Pao2 is less than 50 mm Hg because the drive to breathe depends on hypoxemia rather than hypercarbia. 

TABLE 12-2. Treatment Algorithm for Stable Chronic Obstructive Pulmonary Disease... 

Rennard SI. Treatment of stable chronic obstructive pulmonary disease. Lancet 2004 364 791-802. 

The most serious side effects early in ACS are hypotension, bradycardia, and heart block. Initial acute administration of //-blockers is not appropriate for patients presenting with decompensated heart failure. However, therapy may be attempted in most patients before hospital discharge after treatment of acute heart failure. Diabetes mellitus is not a contraindication to //-blocker use. If possible intolerance to //-blockers is a concern (e.g., due to chronic obstructive pulmonary disease), a short-acting drug such as metoprolol or esmolol should be administered IV initially. 

TREATMENT OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE EXACERBATION... 

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. 

Dougall, I.G., Young, A., Ince, F., and Jackson, D.M., Dual dopamine D2 receptor and / -adrenoceptor agonists for the treatment of chronic obstructive pulmonary disease the pre-clinical rationale, Resp. Med., 97, S3, 2003. 

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. 

Tlotropium bromide (54 Spiriva Boehringer-Ingelheim/Pfizer, 2004) has been approved by the US Eood and Drug Administration (EDA) for the treatment of bronchospasm associated with chronic obstructive pulmonary disease (COPD). Tiotropium, a derivative of atropine from Atropa belladonna (Solanaceae), is a potent reversible nonselective inhibitor of... 

Koumis T, Samuel S. (2005) Tiotropium bromide A new long-acting bron-chodilator for the treatment of chronic obstructive pulmonary disease. Clin... 

Until now we have been discussing natural product HDAC inhibitors and their benefits for pathophysiological conditions. However, recent research shows that for treatment of a few diseased conditions, it is beneficial to increase HDAC activity. One such example is chronic obstructive pulmonary disease (COPD). 

Theophylline reduces contractile activity of smooth musculature, widens bronchi and blood vessels, reduces pulmonary vascular resistance, stimulates the respiratory center, and increases the frequency and power of cardiac contractions. It is used for bronchial asthma, preventing attacks, and systematic treatment. Theophylline is also used for symptomatic treatment of bronchospastic syndrome of a different etiology (chronic obstructive pulmonary disease, chronic bronchitis, and pulmonary emphysema). A large number of combined drags are based on theophylline. Synonyms of theophylline are adophyllin, asthmophyllin, theocin, and many others. 

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. 

Ipratropium has been used concomitantly with other drugs, including beta-adrenergic bronchodilators, sympathomimetic bronchodilators, methyixanthines, steroids, commonly used in the treatment of chronic obstructive pulmonary disease, without adverse drug reactions. 

Chronic obstructive pulmonary disease (COPD) For the long-term, once-daily, maintenance treatment of bronchospasm associated with COPD, including chronic bronchitis and emphysema. 

Chronic obstructive pulmonary disease (COPD) associated with chronic bronchitis For the twice-daily maintenance treatment of airflow obstruction in patients with COPD associated with chronic bronchitis. Fluticasone propionate/salmeterol 250 meg per 50 meg twice daily is the only approved dosage for the treatment of COPD associated with chronic bronchitis. Fligher doses, including fluticasone propionate/salmeterol 500 meg per 50 meg, are not recommended. 

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

Burge S. Should inhaled corticosteroids be used in the long term treatment of chronic obstructive pulmonary disease . Drugs 2001 61(11) 1535-44. Review. 

Pauwels RA, Lofdahl CG, Laitinen LA, Schouten JP, Postma DS, Pride NB, Ohlsson SV. Long-term treatment with inhaled budesonide in persons with mild chronic obstructive pulmonary disease who continue smoking. N Engl J Med 1999 340 1948-53. 

As indicated, most of the analeptic stimulants were used as pharmacological treatments for overdosage of CNS depressants. Doxapram (Dopram) is sometimes used to counteract postanesthetic respiratory depression and as an aid in chronic obstructive pulmonary disease. Pentylenetetrazol (Metrazol) was used experimentally on rare occasions to activate the electroencephalogram. Strychnine is used almost exclusively in animal studies as a tool for studying CNS mechanisms because it is a relatively specific glycine antagonist. 

Ipratropium bromide (Atrovent) is a quaternary amine derivative that is used via inhalation in the treatment of chronic obstructive pulmonary disease and to a lesser extent, asthma. Ipratropium has a slower onset of action (1-2 hours for peak activity) than Pz-adrenoceptor agonists and thus may be more suitable for prophylactic use. Compared with p2-adrenoceptor agonists, ipratropium is generally at least as effective in chronic obstructive pulmonary disease but less effective in asthma. 

PEE-IV Inhibitors Selective inhibitors of phosphodiesterase IV (PDE4) are in development for the treatment of asthma and chronic obstructive pulmonary disease (COPD). Two of them contain fluorine atoms roflumilast (preregistered) bears a difluoromethyl ether and AWD-12-281 (Phase II) has a single fluorine atom (Figure 8.51). 

To reduce toxicity while maintaining therapeutic efficacy, more selective inhibitors of different isoforms of PDE4 were developed (eg, roflumilast, cilomilast, and tofimilast), particularly for the treatment of chronic obstructive pulmonary disease (COPD), but they were abandoned after clinical trials showed that their toxicities of nausea, headache, and diarrhea restricted dosing to subtherapeutic levels. A new generation of selective PDE4 inhibitors is now under development, but none seems close to approval for clinical use. 

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. 

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