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Showing posts with label COPD. Show all posts
Showing posts with label COPD. Show all posts

What are therapeutic options in the management of COPD ?

Smoking cessation is the single most factor that has greatest capacity to influence the natural history of COPD. Health care providers should encourage all COPD patients who smoke to quit smoking.  
  • Pharmacotherapy along with nicotine replacement increase long-term smoking abstinence rates.
  • Regular physical activity gives benefit for COPD patients hence all of them should repeatedly be encouraged to remain active.
  • Appropriate pharmacologic therapy is aimed to reduce COPD symptoms, reduce the frequency and severity of exacerbations, and improve health status and exercise tolerance. 
  • None of the existing pharmacotherapy for COPD has been shown conclusively to modify the long-term reduction in lung function.
  • Influenza and pneumococcal vaccination may be offered depending on local guidelines
Role of smoking Cessation in COPD
Counseling about the need of smoking cessation in COPD patients can increases quit rates over the self-initiated strategies.
Nicotine replacement therapy (nicotine gum, inhaler, nasal spray, transdermal patch, sublingual tablet, or lozenge) and pharmacotherapy with varenicline, bupropion, and nortriptyline can reliably increases long-term smoking abstinence rates 
Role of risk reduction in COPD
Encourage comprehensive tobacco-control policies with clear, consistent, and repeated nonsmoking messages. 
Elimination or reduction of exposures in the workplace as a part of primary prevention. 
Reduce or avoid indoor air pollution from biomass fuel, burned for cooking and heating in poorly ventilated dwellings.
Bronchodilator therapy in COPD 
Bronchodilator therapy play central to the symptomatic management of COPD.
These are prescribed on an as-needed or on a regular basis to prevent or reduce symptoms.  
The principal bronchodilator treatments are the following
beta2-agonists, anticholinergics, theophylline or combination therapy.
The choice of a particular treatment depends on the availability of medications and individual response.
Long-acting inhaled bronchodilators are convenient and they are more effective for symptom relief than short-acting bronchodilators.  
Long-acting inhaled bronchodilators is effective in reducing exacerbations 
Combining bronchodilators of different classes may improve efficacy and it may decrease the risk of side effects compared to increasing the dose of a single bronchodilator.
Role of inhaled steroids in COPD
Regular treatment with inhaled corticosteroids is associated with the following 
  • Improves symptoms of COPD
  • Improvement in lung function and quality of life 
  • Reduces frequency of exacerbations for COPD patients with an FEV1 < 60% predicted.
Inhaled corticosteroid therapy is associated certain side effects such as increased risk of pneumonia.
Withdrawal of inhaled corticosteroids may lead to exacerbations in some patients
Combination of inhaled corticosteroid with a long-acting beta2-agonist is more effective than the individual components in managing COPD.
Chronic treatment with systemic corticosteroids is to be avoided because of increased side effects.
Phospodiesterase-4 inhibitor, Roflumilast
Phospodiesterase-4inhibitor, roflumilast decrease exacerbations treated with oral glucocorticosteroids in patients with severe and very severe COPD,
Theophylline role in COPD 
Theophylline is less effective and less well tolerated compared to inhaled long-acting bronchodilators hence it is not recommended if those drugs are available and they are affordable.  
Combination of theophylline to salmeterol produces a greater improvement in FEV1 and breathlessness than salmeterol alone.  
Low dose theophylline may be useful to reduce exacerbations of COPD.
Influenza vaccines can reduce serious illness.Pneumococcal polysaccharide vaccine is recommended for COPD patients 65 years and older and for those COPD patients younger than 65 years with an FEV1 less than 40% of predicted.
The antibiotics are used for treating infectious exacerbations of COPD as well as other bacterial infections, is currently not indicated
Alpha-1 antitrypsin augmentation therapy not recommended for patients with COPD that is unrelated to the genetic deficiency. 
Mucolytics therapy although overall benefits are very small, patients with viscous sputum may benefit from mucolytics. 
Antitussives are currently not recommended.
Vasodilatorssuch as Nitric oxide is contraindicated in stable COPD.  
All COPD patients get benefit from exercise training programs which improves the exercise tolerance and symptoms of dyspnea and fatigue. 
Although an effective duration of pulmonary rehabilitation program is 6 weeks, the longer the program continues, the more effective the results. 
Lung volume reduction surgery (LVRS) 
It is more efficacious than medical therapy in patients with upper-lobe predominant emphysema and low exercise capacity.  LVRS is costly relative to medical therapy.
In appropriately selected patients with very severe COPD, lung transplantation has been shown to improve quality of life and functional capacity