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By: ms1987 (54 month(s) ago)

very comprehensive..

By: shysha (60 month(s) ago)

Nice presentation

By: drrajatchest (69 month(s) ago)

this presentation can help medical students for better understanding of copd

By: msutton (82 month(s) ago)

This would help with a presentation on COPD for nurse orientees. Could you share it with me please? Meredith

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COPD Brooke Y. Patterson, PharmD, BCPS NU 7080 Advanced Pharmacology Research College of Nursing


Epidemiology 4th leading cause of death in the US Women > Men in recent years Smoking is primary risk factor for COPD Female smokers are more than 13X more likely to die of COPD than non-smokers 12 million Americans diagnosed 20 million more with early evidence of COPD


Definition COPD is a syndrome of chronic limitation in expiratory airflow encompassing emphysema or chronic bronchitis Chronic bronchitis: persistent cough + sputum production for most days out of 3 months in at least 2 consecutive years Emphysema: abnormal permanent enlargement of the airspaces distal to the terminal bronchioles, accompanied by a destruction of their walls and without obvious fibrosis


Diagnosis H/o exposure to risk factors Tobacco smoke Occupational dusts or chemicals Smoke from home cooking and heating fuels Spirometry is gold standard FEV1/FVC <70% and post-bronchodilator FEV1 <80% confirms presence of airflow limitation

Factors Determining Severity of COPD: 

Factors Determining Severity of COPD Severity of symptoms Severity of airflow limitation Frequency and severity of exacerbations Presence of complications of COPD Presence of respiratory insufficiency Co-morbidities General health status # medications needed to manage disease

Pharmacologic Treatment of COPD: 

Pharmacologic Treatment of COPD

Management By Severity: 

Management By Severity

Pharmacotherapeutic Managment: 

Pharmacotherapeutic Managment Bronchodilator medications are mainstay of therapy in COPD Beta-agonists and anticholinergics Combining bronchodilators may improve efficacy and decrease the risk of ADRs compared with increasing dose of a single bronchodilator Steroids in stable COPD Only for symptomatic COPD patients with documented response to steroids on spirometry Combined with long-acting beta-agonist is more effective than individual components Should be used in only 10-20% of COPD paitients

Short-Acting Beta2-Agonists: 

Short-Acting Beta2-Agonists Albuterol (Proventil®, Ventolin®) 2 puffs TID-QID prn Recent supply and re-formulation issues have limited supply and increased cost Metaproterenol (Alupent®) 2 puffs TID-QID prn Levalbuterol (Xopenex®) 2 puffs TID-QID prn Recently available as MDI inhaler Less beta-1 activity; therefore less adverse effects Pirbuterol (Maxair®) 2 puffs TID-QID prn

Long-Acting Beta2-Agonists: 

Long-Acting Beta2-Agonists Slow onset of action; not for acute symptoms 'Controller' inhaler Adverse Effects (less profound due to longer onset of action) Tremor Tachycardia Salmeterol (Servent®) 2 puffs BID Formoterol (Foradil®) 1 cap inhaled BID

Anticholinergic Agents: 

Anticholinergic Agents Minimal cardiac stimulatory effects compared to those of beta agonists Ipratropium (Atrovent®) 2 puffs QID Tiotropium (Spiriva®) 1 cap inhaled QD Ipratropium/albuterol (Combivent®) 2 puffs QID Adverse Reactions Dry mouth Dizziness


Theophylline Use highly NOT recommended MANY drug interactions and adverse effects

Other Pharmacologic Treatments: 

Other Pharmacologic Treatments Smoking cessation Only intervention that slows loss of lung function Influenza vaccine yearly Pneumococcal vaccine NOT recommended Antibiotics Mucolytic agents Antioxidant agents Antitussives LT modifiers


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