Treatment of COPD

Treatment of COPD

Management

Smoking cessation – can slow deterioration, prolong time before disability and death
Drugs

Bronchodilators
- beta-adrenergic agonist - Salbutamol – bronchodilation - less breathless
- antimuscarinic agents – titropium, ipratropium, oxitropium – more prolonged and greater bronchodiation
- patients may find inhalers and spacers difficult to use

Corticosteroids
- prevents inflammation
- prednisolone – 2 weeks initlally
- if there is improvement in airflow – stop prednisolone, add inhaled corticosteroid

Antibiotics
- should be given in acute exacerbations of COPD, as it can prevent hospitalisation and further lung damage
- patients should have antibiotics at home – as soon as their sputum turns yellow/green, they should take them
- amoxicillin-resistant H. Influenza – use co-amoxiclav
- eradication of infection and keeping lower respiratory tract free of bacteria can help to prevent deterioration of lung function

Diuretic treatment
- required for oedematous patients
- Loop diuretics (frusemide), thiazide diuretics (idapamide), potassium sparing diuretics (spironolactone, eperenone)
- Daily weights should be recorded during acute episodes in hospital

Alpha-1 antitrypsin replacement
- Recommended for patients with a serum level of this below 310 mg/L and abnormal lung function
- Low alpha-1 antitrypsin – primary manifestation is emphysema
- It is still uncertain whether this modifies the long term progression of COPD

Vaccines
- Yearly influenza vaccine
- Polyvalent pneumococcal vaccine – lifetime

Treatment of respiratory failure
· Primary aim – increase arterial oxygen pressure with oxygen therapy
o Type I respiratory failure (low arterial oxygen pressure, normal carbon dioxide arterial pressure) - safe to administer as much oxygen as needed to return arterial oxygen pressure to normal
o Type II respiratory failure à arterial carbon dioxide pressure is elevated - additional oxygen will lead to a rise in arterial carbon dioxide pressure (small increases can be tolerated, but not if the pH falls, especially if it falls below 7.25 - use respiratory stimulant or artificial ventilation
o Initially, 24% oxygen is given à can be increased if arterial carbon dioxide pressure does not rise to unacceptable levels

· Removal of retained secretions
o Encourage patient to cough to remove secretions
o Physiotherapy, bronchoscopy, aspiration via an endothelial tube

· Respiratory support
o Tight-fitting facial masks – deliver positive airway pressure ventilator support

· Respiratory stimulants
o Doxapram – iv – stimulates coughing, can help clear secretions

· Corticosteroids, antibiotics and bronchodilators in acute periods

- Rushmi