Terapéutica respiratoria

Global Strategy for Diagnosis, Management and Prevention of COPD

Differential Diagnosis:
COPD and Asthma
COPD
• Onset in mid-life
• Symptoms slowly
progressive
• Long smoking history
© 2013 Global Initiative for Chronic Obstructive Lung Disease
ASTHMA
• Onset early in life (often
childhood)
• Symptoms vary from day to day
• Symptoms worse at night/early
morning
• Allergy, rhinitis, and/or eczema
also present
• Family history of asthma
FISIOPATOLOGÍA DEL ASMA

Source: Peter J. Barnes, MD

FISIOPATOLOGÍA DEL ASMA
FISIOPATOLOGÍA DEL ASMA
FISIOPATOLOGÍA DEL ASMA: Fenotipos del asma
FUENTES
Clasificación del ASMA
 REDUCE
LEVEL OF CONTROL TREATMENT OF ACTION

maintain and find lowest

controlled
controlling step
consider stepping up to
partly controlled gain control

INCREASE
uncontrolled step up until controlled

exacerbation treat as exacerbation

REDUCE INCREASE
TREATMENT STEPS
STEP STEP STEP STEP STEP
1 2 3 4 5
© Global Initiative for Asthma
Grado de control del asma
 Controller Medications

 Inhaled glucocorticosteroids
 Leukotriene modifiers

 Long-acting inhaled β2-agonists in combination

with inhaled glucocorticosteroids
 Systemic glucocorticosteroids

 Theophylline

 Cromones

 Anti-IgE

© Global Initiative for Asthma

 Reliever Medications

 Rapid-acting inhaled β2-agonists

 Systemic glucocorticosteroids
 Anticholinergics
 Theophylline
 Short-acting oral β2-agonists

© Global Initiative for Asthma

TRATAMIENTO DEL ASMA: Administración inhalatoria
TRATAMIENTO DEL ASMA: Administración inhalatoria
TRATAMIENTO DEL ASMA: Administración inhalatoria
TRATAMIENTO DEL ASMA: Administración inhalatoria
TRATAMIENTO DEL ASMA:
TRATAMIENTO DEL ASMA:
TRATAMIENTO DEL ASMA: Agonistas b2-adrenérgicos
TRATAMIENTO DEL ASMA: Agonistas b2-adrenérgicos
TRATAMIENTO DEL ASMA: Agonistas b2-adrenérgicos
 Estimate Comparative Daily Dosages for
Inhaled Glucocorticosteroids by Age

Drug Low Daily Dose (g) Medium Daily Dose (g) High Daily Dose (g)
> 5 y Age < 5 y > 5 y Age < 5 y > 5 y Age < 5 y
Beclomethasone 200-500 100-200 >500-1000 >200-400 >1000 >400

Budesonide 200-600 100-200 600-1000 >200-400 >1000 >400

Budesonide-Neb 250-500 500-1000 >1000

Inhalation Suspension

Ciclesonide 80 – 160 80-160 >160-320 >160-320 >320-1280 >320

Flunisolide 500-1000 500-750 >1000-2000 >750-1250 >2000 >1250

Fluticasone 100-250 100-200 >250-500 >200-500 >500 >500

Mometasone furoate 200-400 100-200 > 400-800 >200-400 >800-1200 >400

Triamcinolone acetonide 400-1000 400-800 >1000-2000 >800-1200 >2000 >1200

© Global Initiative for Asthma

TRATAMIENTO DEL ASMA: Glucocorticoides inhalados
TRATAMIENTO DEL ASMA: Glucocorticoides inhalados
TRATAMIENTO DEL ASMA: Glucocorticoides inhalados
TRATAMIENTO DEL ASMA: Antileucotrienos
TRATAMIENTO DEL ASMA: Teofilina
TRATAMIENTO DEL ASMA: Teofilina
TRATAMIENTO DEL ASMA: Teofilina
TRATAMIENTO DEL ASMA: Omalizumab
Omalizumab: farmacocinética
Omalizumab: farmacocinética
Omalizumab: eficacia clínica
Omalizumab: eficacia clínica
Omalizumab: eficacia clínica
Mepolizumab: mAb anti-IL5
Mepolizumab: mAb anti-IL5
Mepolizumab: mAb anti-IL5
EPOC
EPOC
 Global Strategy for Diagnosis, Management and
Prevention of COPD

Combined Assessment
of COPD
When assessing risk, choose the highest risk
according to GOLD grade or exacerbation
history. One or more hospitalizations for COPD
exacerbations should be considered high risk.)

Patien Characteristic Spirometric Exacerbations mMRC CAT

t Classification per year
Low Risk
A GOLD 1-2 ≤1 0-1 < 10
Less Symptoms
Low Risk
B GOLD 1-2 ≤1 >2 ≥ 10
More Symptoms
High Risk
C GOLD 3-4 >2 0-1 < 10
Less Symptoms
High Risk ≥ 10
D GOLD 3-4 >2 >2
More Symptoms
© 2013 Global Initiative for Chronic Obstructive Lung Disease
 Global Strategy for Diagnosis, Management and Prevention of COPD
Therapeutic Options: COPD Medications

Beta2-agonists
Short-acting beta2-agonists
Long-acting beta2-agonists
Anticholinergics
Short-acting anticholinergics
Long-acting anticholinergics
Combination short-acting beta2-agonists + anticholinergic in one inhaler
Methylxanthines
Inhaled corticosteroids
Combination long-acting beta2-agonists + corticosteroids in one inhaler
Systemic corticosteroids
Phosphodiesterase-4 inhibitors

© 2013 Global Initiative for Chronic Obstructive Lung Disease

 Global Strategy for Diagnosis, Management and Prevention of COPD

Manage Stable COPD: Goals of Therapy

 Relieve symptoms
 Improve exercise tolerance Reduce
symptoms
 Improve health status

 Prevent disease progression

 Prevent and treat exacerbations Reduce
risk
 Reduce mortality

© 2013 Global Initiative for Chronic Obstructive Lung Disease

 Global Strategy for Diagnosis, Management and Prevention of COPD
Manage Stable COPD: Pharmacologic Therapy
(Medications in each box are mentioned in alphabetical order, and therefore not necessarily in
order of preference.)

Patient Recommended Alternative choice Other Possible

First choice Treatments
LAMA
SAMA prn or
A or LABA Theophylline
SABA prn or
SABA and SAMA
LAMA
SABA and/or SAMA
B or LAMA and LABA
Theophylline
LABA
ICS + LABA LAMA and LABA or
or LAMA and PDE4-inh. or SABA and/or SAMA
C
LAMA LABA and PDE4-inh. Theophylline

ICS + LABA ICS + LABA and LAMA or

Carbocysteine
and/or ICS+LABA and PDE4-inh. or
D SABA and/or SAMA
LAMA LAMA and LABA or
Theophylline
LAMA and PDE4-inh.
EPOC: Bloqueantes muscarínicos
EPOC: Tiotropio
EPOC: Terapia broncodilatadora dual
EPOC: Terapia broncodilatadora dual
EPOC: Terapia broncodilatadora dual
EPOC: Terapia inhalatoria triple
EPOC: Terapia inhalatoria triple