COPD medications

As a new therapy for COPD, tiotropium was evaluated as an addition to standard COPD medications in a 1-year, placebo-controUed, double-blind study involving over 900 subjects. Tiotropium 18 meg/ day improved the FEVi response an average of 12% (trough) to 22% (peak) when added to standard therapy. ... 

Table 6.2 Airflow resistances and flow rales corresponding with 4 kPa pressure drop for a number of currently marketed dry powder inhalers with asthma and COPD medication...

O Inflammation plays a key role in the pathophysiology of COPD, but it differs from that seen in asthma therefore, the use of and response to anti-inflammatory medications are different. 

COPD is the fourth leading cause of death in the United States in 2000,119,000 adults died from the disease.3 In 2002, COPD was estimated to cost the United States 32.1 billion, with direct medical costs accounting for 18 billion of the total.3 Morbidity, mortality, and costs are all expected to increase over the next decade. 

Inflammation is present in the lungs of all smokers. It is unclear why only 15% to 20% of smokers develop COPD, but susceptible individuals appear to have an exaggerated inflammatory response.5 O The inflammation of COPD differs from that seen in asthma, so the use of anti-inflammatory medications and the response to those medications are different. The inflammation of asthma is mainly mediated through eosinophils and mast cells. In COPD the primary inflammatory cells include neutrophils, macrophages, and CD8+ T lymphocytes. 

Patients with COPD are initially asymptomatic. The disease is usually not diagnosed until declining lung function leads to significant symptoms and prompts patients to seek medical care. 

The medications available for COPD are effective for reducing or relieving symptoms, improving exercise tolerance, reducing the number and severity of exacerbations, and improving quality of life. No medications presently available have been shown to slow the rate of decline in lung function. 

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. 

Upon discontinuation of inhaled corticosteroids some patients may experience deterioration in lung function and an increase in dyspnea and mild exacerbations it is reasonable to reinstitute the medication in these patients.25 Completion of ongoing clinical trials assessing mortality should help to clarify the role of corticosteroid treatment of COPD. 

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 use of these agents can be continued as medically indicated to control recurring bouts of bronchospasm. If a previously effective regimen fails to provide the usual relief, medical advice should be sought immediately, as this is often a sign of worsening COPD, which would require reassessment of therapy. 

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. 

The pharmacists of Care-Rite Pharmacy also developed patient educational tools to be used during the patient assessment and patient education components of the Pharmacy Check-up Service. Because many of the targeted patients have similar medical conditions, education materials were developed for specific disease states, including hypertension, ischemic heart disease, diabetes, asthma, chronic obstructive pulmonary disease (COPD), etc. Also, educational materials were developed for certain therapeutic classes of medications. The Care-Rite pharmacists also determined that many patients needed individualized education materials, so they implemented a drug information/educational service as part of the MTM service. With this service, patients can ask questions regarding their medical conditions and/or drug therapies. The pharmacists will research and provide an individualized written response for each patient. 

Her previous medical history includes chronic obstructive pulmonary disease (COPD) for fO years, last admission to hospital was two weeks ago ischaemic heart disease since 1995, myocardial infarction 4 years ago osteoporosis diagnosed 3 years ago hypertension diagnosed 9 years ago and pulmonary embolism two months ago. 

Mr CD, a 75-year-old man, 1.7 m tall, is admitted to hospital very short of breath. He used to work in the docks as a clerk and has smoked 40 cigarettes daily for 30 years and stopped 2 years ago. His previous medical history includes COPD, recurrent infective exacerbations since 1991, no LTOT type 2 diabetes mellitus on insulin 14 IU b.d. for 20 years, retinopathy ischaemic heart disease - coronary artery bypass graft (twice), hypertension myocardial infarction 1986 atrial fibrillation high cholesterol. 

COPD is linked with other co-morbid conditions. Patients are more likely to have ischaemic heart disease, pneumonia and diabetes, making treatment more complicated and requiring a holistic approach to care. This patient demonstrates five co-morbidities. These in turn impact on the medication load she has to cope with, so concordance is important. 

A 55-year-old man is hospitalized for observation after an anginal attack. He suddenly develops shortness of breath and fatigue and tells his nurse that his heart feels like its ready to "jump out" of his chest. His ECG monitor shows AF with a ventricular rate of 160 beats/min. PMH COPD and diabetes. Which of the following medications is best to control his ventricular rate ... 

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