m What is Chronic obstructive pulmonary

( COPD) disease?
m COPD is a progressive disease that limits
the function of the lungs by Loss of lung
function.
m The airway in lungs are blocked and
breathing takes more effort.
m Currently in USA, more then 36.1 million
people are suffering with COPD
m 119,000 deaths from COPD per year
m COPD is 4th leading cause of death in
the U.S.
m In short it is a lung problem steaming
form smoking to exposure to other toxins
including environmental that damages
respiratory system.
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Stage I ëMild airflow limitation and
Mild sometimes, but not always
ëchronic cough and sputum
production present
Stage II ëWorsening airflow limitation with
Moderate shortness of breath typically
developing during exertion.
ëThis is the stage at which patients
typically seek medical attention

Stage III ëFurther worsening of airflow limitation

Severe greater shortness of breath, reduced
exercise capacity, and repeated
exacerbations which have an impact
on patients· quality of life.

Stage IV ëSevere airflow limitation

Very Severe At this stage, quality of life is very
appreciably impaired and
exacerbations may be
lifethreatening.
m Smoking
m Occupational Exposure
m Air Pollution
m Genetic
m Auto Immune Diseases
m Risk Factors
u Asthma
u Repeated Lung infection
u Diet High in Cured Meat
u Labor breathing
u Lack of energy
u Irritability
u Frustration
u Headache
u drowsiness
u Chronic cough with sputum production
u Chest tightness
u Tachypnea
u Wheezing sound and crackles heard while
auscultation.
u Exhalation is longer then inhalation
u Enlargement of chest ( Ant-Post) ( Barrel
Chest)
u Active use of neck muscles
u Breathing through pursed lips
u Cyanosis
u Peripheral edema
m Oxidative stress produce by free radicals
in inhaled air
m Cytokine release response due to irritant
particles
m Narrow airway limiting the effectiveness
of the lungs
m Dynamic hyperinflation
m Loss of surface area ( reduction in gas
exchange)
m Spirometry
u Breathing test which measures the amount and rate
at wich air can pass through
m Lung function test
m Bronchodilator Reversibility Test
u Relaxing tightened muscles around the airway and
opening up airway to ease breathing
m Chest X-ray
m Computed tomography
m MRI
m Arterial Blood gas measurement
u Shows oxygen level in blood
m Rehabilitation
u Regular exercise, good nutrition, Flu and
Pneumonia vaccines
m Smoking cessation and elimination Of
environmental irritant
m Oxygen Therapy
m Nicotine Patch
m Bronchodilator
u Anticholinergic
 Ipratopium
 Tiotropium
u Beta-2 Agonist
 Albuterol
 Levabuterol
 Salmeterol
 Formoterol
 Faromoterol
m Corticosteroid
 Fluticason
 Budesonide
 Prednison
m Expactront
 Guaifenesin
m Theophyline
 Aminophyline
m Antibiotics
 Cefuroxime (2nd Generation Ceph. )
 Azithromycine
 Clarithromycine
m Surgery
 Bullectomy
 Lung volume Reduction Surgery
 Lung Transplant
m No specific manifestation related to
COPD are reported
m 1st : Oral pathogens may be inhaled
m 2nd: Action of bacterial enzymes on oral
epithelial cells may promote colonization
by respiratory pathogens
m 3rd: Bacterial enzymes may reduce the
protection against colonization provided
by mucosal secretions
m 4th: Cytokine may contribute to
colonization of the respiratory epithelium
m Bronchodilator
u Anticholinergic
 Ipratopium
 Drugs with anticholinergic properties (eg, dronabinol)
may increase toxicity; albuterol may increase effects
u Beta-2 Agonist
 Albuterol
 Beta-adrenergic blockers antagonize effects; inhaled ipratropium
may increase duration of bronchodilatation by albuterol;
cardiovascular effects may increase with MAOIs, inhaled
anesthetics, TCAs, and sympathomimetic agents
 Salmeterol
 Concomitant use of beta-blockers may decrease bronchodilating
and vasodilating effects of beta agonists; concurrent administration
with methyldopa may increase pressor response; coadministration
with oxytocic drugs may result in severe hypotension; ECG changes
and hypokalemia resulting from diuretics may worsen when
coadministered with salmeterol
 Formoterol
 Concomitant use of beta-blockers may decrease bronchodilating
and vasodilating effects of beta-agonists such as salmeterol;
concurrent administration with methyldopa may increase pressor
response; coadministration with oxytocic drugs may result in severe
hypotension; ECG changes and hypokalemia resulting from
diuretics may worsen when coadministered with salmeterol
m Corticosteroid
 Fluticason
 None reported
 Budesonide
 None reported
 Prednison
 Coadministration with estrogens may decrease
prednisone clearance; concurrent use with digoxin
may cause digitalis toxicity secondary to
hypokalemia; phenobarbital, phenytoin, and rifampin
may increase metabolism of glucocorticoids
(consider increasing maintenance dose); monitor for
hypokalemia with coadministration of diuretics
m Theophyline
 Aminophyline
 Aminoglutethimide, barbiturates, carbamazepine,
ketoconazole, loop diuretics, charcoal, hydantoins,
phenobarbital, phenytoin, rifampin, isoniazid, and
sympathomimetics may decrease effects of
theophylline; theophylline effects may increase with
allopurinol, beta-blockers, ciprofloxacin,
corticosteroids, disulfiram, quinolones, thyroid
hormones, ephedrine, carbamazepine, cimetidine,
erythromycin, macrolides, propranolol, and interferon
m Antibiotics
 Cefuroxime (2nd Generation Ceph. )
 Disulfiramlike reactions may occur when alcohol is consumed within 72 h after
taking cefuroxime; may increase hypoprothrombinemic effects of
anticoagulants; may increase nephrotoxicity in patient receiving potent
diuretics such as loop diuretics; coadministration with aminoglycosides
increase nephrotoxic potential
 Azithromycine
 May increase toxicity of theophylline, warfarin, and digoxin; effects are
reduced with coadministration of aluminum and/or magnesium antacids;
nephrotoxicity and neurotoxicity may occur when coadministered with
cyclosporine
 Clarithromycine
 Toxicity increases with coadministration of fluconazole, astemizole, and
pimozide; clarithromycin effects decrease and GI adverse effects may
increase with coadministration of rifabutin or rifampin; may increase toxicity
of anticoagulants, cyclosporine, tacrolimus, digoxin, omeprazole,
carbamazepine, ergot alkaloids, triazolam, and HMG CoA-reductase
inhibitors; cardiac arrhythmias may occur with coadministration of cisapride;
plasma levels of certain benzodiazepines may increase, prolonging CNS
depression; arrhythmias and increase in QTc intervals occur with
disopyramide; coadministration with omeprazole may increase plasma levels
of both agents
m Nicotine Patch
May decrease diuretic effects of
furosemide and decrease cardiac
output; may decrease absorption of
glutethimide; may increase circulating
cortisol and catecholamines; not for use
in patients who continue to smoke, use
snuff, chew tobacco, or use other
nicotine products because it may
increase toxicity of nicotine
m Contra indications with COPD
u Narcotic Analgesics
u Diazepam, Lorazepam
u Nitrous Oxide
u Epinephrine
u Avoid Aspirin, Indocine, NSAID, Penicillin,
Narcotics, Antihistamines, anticholinergics
m Review history for concurrent heart disease
m Avoid treatment if upper respiratory tract
infection is present
m Treat in upright position
m Avoid rubber dam in severe cases
m Use pulse oximetry (if pulse ox <91%, use low
flow 2-3L/min)
m If patient is on steroid regimen, supplement
as needed
m Drug interactions with COPD medication