COPD and

The use of antibiotics is not recommended, except for the treatment of infectious exacerbations of COPD and other bacterial infections. Influenza vaccines decrease illness and death in COPD patients. Pneumococcal vaccination is also recommended. 

In symptomatic patients with severe COPD and frequent exacerbations, regular treatment with inhaled corticosteroids decreases the number of exacerbations per year and improves health status however, corticosteroids do not slow the longterm decline in pulmonary function. 

Pulmonary hypertension develops late in the course of COPD, usually after the development of severe hypoxemia. It is the most common cardiovascular complication of COPD and can result in cor pulmonale, or right-sided heart failure. Hypoxemia plays the primary role in the development of pulmonary hypertension by causing vasoconstriction of the pulmonary arteries and by promoting vessel wall remodeling. Destruction of the pulmonary capillary bed by emphysema further contributes by increasing the pressure required to perfuse the pulmonary vascular bed. Cor pulmonale is associated with venous stasis and thrombosis that may result in pulmonary embolism. Another important systemic effect is the progressive loss of skeletal muscle mass, which contributes to exercise limitations and declining health status. 

Theophylline is a non-specific phosphodiesterase inhibitor that increases intracellular cAMP within airway smooth muscle resulting in bronchodilation. It has a modest bronchodila-tor effect in patients with COPD, and its use is limited due to a narrow therapeutic index, multiple drug interactions, and adverse effects. Theophylline should be reserved for patients who cannot use inhaled medications or who remain symptomatic despite appropriate use of inhaled bronchodilators. 

Smoking cessation is the most effective strategy to reduce the risk of developing COPD and the only intervention proven to affect the longterm decline in FEVj and slow the progression of COPD. 

Prescott, E., Lange, P, and Vestbo, J., Chronic mucus hypersecretion in COPD and death from pulmonary infection, Eur. Respir. J. 8, 8, 1333, 1995. 

The database for HFC-134a is extensive it contains studies with both human subjects and animal models. Potentially sensitive populations, including patients with COPD and adult and pediatric asthmatic patients, were tested with direct inhalation of HFC-134a from metered-dose inhalers. The response of these groups was no different than that of healthy adults. The animal studies covered acute, subchronic, and chronic exposure durations and addressed systemic toxicity as well as neurotoxicity, reproductive and developmental effects, cardiac sensitization, genotoxicity, and carcinogenicity. The metabolism of HFC-134a is well understood, and the relationship of exposure con... 

Intraspecies 1—this no-effect concentration for eight healthy individuals was far below concentrations causing effects in animals. At this low exposure concentration there was no indication of differences in sensitivity among the subjects. This uncertainty factor is supported by the lack of effects in COPD and adult and pediatric asthmatic patients treated with metered-dose inhalers containing HFC-134a as a propellant. 

A survey about the dietary habits within the scope of the "National Health and Nutritional Examination Survey" showed that an inverse correlation (Morabia et al., 1989) exists between COPD and vitamin A supply as the only one of 12 examined dietary components. If a diminished supply of vitamin A increases the appearance of obstructive respiratory diseases, a marginal or local vitamin A deficit could be responsible for the observed changes of the respiratory mucosa. Such a deficit results in a loss of cilia, an increase of secreting cells and finally the formation of squamous metaplasia (Biesalski et al., 1985 Chytil, 1985 Shah and Rajalekshmi, 1984). 

The inflammation in asthmatics also causes an associated increase in airway responsiveness to a variety of stimuli. The structural and inflammatory changes of COPD and asthma are described in detail elsewhere. 

Reversibility tests to bronchodilators are recommended at all stages of obstructive airways diseases. They are helpful in differentiating patients with COPD with those of asthma. Many patients with COPD and even those with severe airflow obstruction can demonstrate (partial) reversibility. Patients with a positive bronchodilator response i.e. reversibility are more likely to respond to a trial of oral or inhaled corticosteroids. 

This xanthine derivative is an only a modest bron-chodilator in COPD, and because of its narrow therapeutic range, frequently seen adverse effect and drug interactions, it is becoming less frequently used, some patients experience side effects even within the therapeutic range. The non-bronchodilator effects of theophylline such as systemic and pulmonary vascular dilatation, central nervous system stimulation, improvement of the strength and effectiveness of respiratory muscles and possibly anti-inflammatory effects are of disputed clinical significance at usual therapeutic levels. 

Presently, inhaled steroids (up to the equivalent of BDP 1000 pg/d, budesonide 800 pg/d, fluticasone 500 pg/d) should be given to patients who show an objective response to either oral or inhaled steroids (s. corticosteroid reversibility testing). For those patients who experience no symptomatic relief, the currently available evidence does not support the use of ICS for alteration of the natural history of the disease. Nevertheless, corticosteroids are effective in treating acute exacerbations in COPD and taking patients of off their ICS regimen may lead to deterioration. Oral corticosteroids (e.g. 40 mg prednisolone for ten days) are recommended for exacerbations, if... 

Wouters EF, Postma DS, Fokkens B, Hop WC, Prins J, Kuipers AF, Pasma HR, Hensing CA, Creutzberg EC, COSMIC (COPD and Seretide a Multi-Center Intervention and Characterization) Study Group. Withdrawal of fluticasone propionate from combined sahneterol/fluticasone treatment in patients with COPD causes immediate and sustained disease deterioration a randomised controlled hial. Thorax 2005 60(6) 480-7. 

Adenosine A3 Receptor in Asthma, COPD and Allergic Rhinitis... 

Inhalation aerosols have been used for the delivery of drugs to the respiratory system since the mid-1950s. The most common dosage form for inhalation is the metered-dose inhaler (MDI), by which the drug is delivered from a pressurized container using a liquefied gas propellant. Medication delivered via this dosage form has allowed for a quick therapeutic response to the symptoms of asthma, emphysema, and chronic obstructive pulmonary disease (COPD), and has resulted in an improvement in the quality of life for millions of asthma sufferers. 

His present medical history includes chronic obstructive pulmonary disease (COPD) and urinary incontinence. The pharmacy Patient Medication Record (PMR) includes latanoprost drops for glaucoma which was dispensed six months ago. 

Ipratropium (Atrovent Inhaler) - regular treatment of reversible bronchospasm associated with COPD and chronic asthma (also tiotropium). 

Voshaar, T., Hausen, T., Kardos, P, et al. (2005), Inhalation therapy with respimat soft inhaler in patients with COPD and asthma, Pneumologie, 59,25-32. 

Q2 Describe the major types of COPD and compare the conditions you identify. 

Q11 Smoking is the most important risk factor in the development of COPD and is considered the single greatest cause of preventable illness. Stopping smoking both reduces the risk of heart disease and decreases mortality from COPD. 

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