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

1. Shahirah Zainudi
RPh.3960
Pharmacist
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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.
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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.

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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.

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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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Manage Stable COPD

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Short Acting Bronchodilators
(SABA & SAMA)

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1 puff bd

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1-2 puff bd
maximum :
12puff/day
Max:4puff/day

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.
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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.

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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.

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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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