This document discusses medication use in chronic lung diseases like COPD. It covers different classes of bronchodilators and anti-inflammatory drugs used to treat symptoms and exacerbations. These include beta agonists, antimuscarinics, methylxanthines, inhaled corticosteroids, oral glucocorticoids, PDE-4 inhibitors, antibiotics, and mucolytics. It provides guidance on individualizing treatment based on a patient's severity, risk factors, and comorbidities. Vaccines for influenza and pneumonia are also recommended. The document outlines management of stable COPD and exacerbations with short-acting bronchodilators and systemic corticosteroids. It discusses the risks and benefits of various maintenance
2. Introduction
Medication use in chronic lung disease
a) Bronchodilator
q Beta2 agonists,
q Anti muscarinics
q Methylxanthines
q Combination bronchodilator therapy
b) Antiinflammatory agents
q Inhaled corticosteroids (ICS)
q Oral glucocorticoids
q PDE-4 Inhibitors
q Antibiotics
q Mucolytics/antioxidants
q Other anti-inflammatory agents
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3. Chronic lung disease is a term used for a number of
disease that attack the lungs for the long term. This
disease prevents air flow from inside the lungs so that
people will have difficulty in breathing1.
3
4. Chronic Obstructive Pulmonary Disease (COPD)
is a common, preventable and treatable disease
that is characterized by persistent respiratory
symptoms and airflow limitation that is due to
airway and/or alveolar abnormalities usually
caused by significant exposure to noxious
particles or gases.
6. Each pharmacologic treatment regimen should be
individualized and guided by the
◦ severity of symptoms,
◦ risk of exacerbations,
◦ side-effects,
◦ comorbidities,
◦ drug availability and cost, and
◦ the patient’s response, preference and ability to use various
drug delivery devices.
11. Influenza vaccine
Can reduce serious illness and death in COPD
patients.
Pneumococcal vaccine
-PCV 13 & PPSV23, are recommended for all patients
> 65y.o.
-PPSV 23 is also recommended for younger COPD
patients with significant co morbid conditions
including chronic heart or lung disease.
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21. Have numerous side effects, including steroid
myopathy which can contribute to muscle
weakness, decreased functionality and
respiratory failure in patients with severe COPD.
It plays a role in the acute management of
exacerbations.
They have no role in the chronic daily treatment
in COPD because of a lack of benefit against a
high rate of systemic complications. 21
22. Theophylline works as an anti-inflammatory
drug and relaxes the muscles in the airways.
Theophylline comes as a pill.
22
23. 23
o Beneficial effect : greater in patients with
a prior history of hospitalization for an
acute exacerbation. Currently, no study
directly comparing roflumilast with an
inhaled corticosteroid.
o Adverse effect : nausea, reduced
appetite, weight loss, abdominal pain,
diarrhoea, sleep disturbance &
headache.
25. 25
250mg/day or 500mg
3x/week
§ There are no data showing the efficacy or safety of
azithromycin treatment to prevent COPD exacerbations
beyond one year of treatment.
26. In COPD patients not receiving inhaled
corticosteroids, regular treatment with
mucolytics
e.g Carbosysteine and N-acetylcysteine may
reduce exacerbations and modestly improve
health status.
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27. Alpha-1 antitrypsin augmentation therapy
◦ Intravenous augmentation therapy may slow down
the progression of emphysema
ØAntitussives
◦ There is no conclusive evidence
of a beneficial role of antitussives in patients with
COPD.
Ø Vasodilators
◦ Vasodilator do not improve outcomes and may
worsen oxygenation. E.g Sildenafil does not
improve the results of rehabilitation in patients with
COPD and moderately increases pulmonary artery
pressure.
39. 1. MH Themes, (2018). Chronic Lung Disease Definition in Medical,
WordPress at http://diseasedetail.com/chronic-lung-disease-
definition/ accessed on 3rd May 2018.
2. GOLD GUIDELINE 2019, Pocket Guide to COPD Diagnosis,
Management & Prevention , A Guide for Health Cafe Professionals
2019 Report
3. Ashraf El Adawy (2017). Optimising treatment for COPD. Accessed
https://www.slideshare.net/ashrafeladawy/optimising-treatment-
for-copd on 3rd May 2018.
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