Pharmacology Lecture Slides on COPD - Chronic obstructive pulmonary disease by Sanjaya Mani Dixit Assistant Professor of Pharmacology at Kathmandu Medical College

1. COPD
Sanjaya Mani Dixit
Assistant Prof of Pharmacology

2. Contents
• Introduction
• Causes
• Precipitating factors
• Treatment Goals
• Drugs in COPD
– Bronchodilators
– Corticosteroids
– Oxygen Therapy
– Antibiotics
• COPD Vs Asthma– Cough

4. http://ismm.org/tl_files/archive/1998/July/ISMM%20News%207%201998%20COPD%20in%20Nepal.pdf

5. COPD
WORLD COPD DAY
-November 14 ( 2012)
-November 20 ( 2013)
Chronic obstructive lung
disease (COLD)
Chronic obstructive airways
disease (COAD)
In 2000, the WHO
estimated 2.74
million COPD deaths
worldwide.

6. COPD
• Chronic obstructive pulmonary disease (COPD)
is a preventable and treatable disease state
characterized by airflow limitation that is not
fully reversible.
• The airflow limitation is usually progressive
and is associated with an abnormal
inflammatory response of the lungs to noxious
particles or gases, primarily
caused by cigarette smoking.

7. COPD
C.O.P.D.is a mixture of 3
separate disease processes.
Chronic bronchitis,
Emphysema and,
Asthma (to a lesser extent).
Each case of COPD is unique in the blend of processes.
Chronic obstructive lung disease produces an
obstruction to airflow and ultimately can affect both the
mechanical function of the lung and the gas exchange
capability of the lung.

11. Orthopneic -- difficult or painful breathing except in an erect sitting or
standing position

13. Causes of COPD
• Cigarette smoking has been shown
to be contributing factor in the
early development and severity of
COPD.
• Air pollution and occupational
exposures play roles too.
• Modern medicine has created an
ever increasing geriatric
population. As people live longer,
the problem of COPD become more
and more a sociologic problem as
well as medical problem.

14. COPD- Precipitating factors
• The word chronic indicates an ever present and continuing
entity, therefore , COPD is a progressive irreversible , and
degenerative process.
• The major obstructive lung disorders are usually divided into
many categories which are due to:
1-Reversabile factor --e.g. inflammation, bronchospasm,
mucus plugging
2-Irreversible factors --e.g. thickened fibrotic airway wall,
damaged alveoli leading to loss of radial traction and
unsupported airways.
3-Localized lesion-- e.g. tumor, foreign body.

15. COPD and
Co-existing
diseases
COPD and
Leading
causes of
death

16. Treatment goals for COPD:
1) prevention of disease progression;
2) relief of symptoms;
3) improvement in exercise tolerance;
4) improvement in health status;
5) prevention and treatment of exacerbations;
6) prevention and treatment of complications;
7) a reduction in mortality; and
8) minimization of side-effects from treatment

17. Drugs in COPD
• Oxygen therapy
• Bronchodilators
• Corticosteroids (Acute Exacerbations)
• Antibiotics for COPD exacerbation

18. Bronchodilators
• Provides symptomatic benefit
• Bronchodilators are the most important agents in the
pharmacologic management of patients with COPD.
• Do not decrease decline in lung function but offer
improvement in airflow, symptoms, exercise tolerance, and
overall health status.
1. Anticholinergic -- Ipratropium bromide
2. Short-acting Beta2-agonists---Salbutamol, Terbutaline
(Inhalation route)
3. Oral Theophylline

19. Ipratropium bromide
• Anticholinergic drug (Antimuscarinic)-short acting
• Bronchodilators of choice in COPD.
• Produce slower response than inhaled sympathomimetics hence
better suited for regular prophylaxis rather than acute cases.
• Patients of asthamatic bronchitis and psychogenic asthma
respond better to anticholinergic drugs.
• Combination of inhaled Ipratropium with B2-agonist produces
more marked & longer lasting bronchodilatation.
S/E
Dry mouth and decreased mucociliary clearance
Dilated pupil, photophobia , blurred vision
Urinary continence problem

20. Salbutamol
• Highly selective Beta2 adrenergic agonist
• Quicker actions on inhalation
• Produces bronchodilation within 5 mins and action
lasts for 2-4 hrs.
C/U
– COPD
– Asthma attacks
S/E
Muscle tremors, throat irritation, ankle edema
Palpitation, restlessness, nervousness

21. Terbutaline
Terbutaline is a Beta2-selective bronchodilator.
It is effective orally, subcutaneously, or by inhalation.
Effects are observed rapidly after inhalation or parenteral
administration; after inhalation, its action may persist for 3–6
hours.
Terbutaline is used for
• COPD
• Long-term treatment of obstructive airway diseases
• Acute bronchospasm
• Emergency treatment of status asthmaticus

22. Methylxanthine
• Theophylline produces modest improvements in
expiratory flow rates and vital capacity and a slight
improvement in arterial oxygen and carbon dioxide
levels in patients with moderate to severe COPD.
• Theophylline directly relaxes human airways smooth
muscle in vitro and, like β2- agonists, acts as a
functional antagonist, preventing and reversing the
effects of all bronchoconstriction agonists.

23. Corticosteroids
• Potent immunosuppressant and anti-inflammatory
• Oral corticosteroids (equivalent to 0.5 mg/kg/d of
prednisone for 14–21 days) and inhaled (fluticasone)
(6–12 weeks of therapy) corticosteroids are common.
• Long term use has serious disadvantages
• S/E-
– Stomach irritation, such as indigestion, Peptic ulcer (long)
– Tachycardia, nausea, insomnia, metallic taste
– Weight gain, thinning skin, muscle weakness, weakening of
bones (osteoporosis), high blood pressure

24. http://www.webmd.com/lung/copd/corticosteroids-for-chronic-obstructive-pulmonary-disease-copd

25. http://www.globalrph.com/steroid.cgi

26. Methylprednisolone
• Usually given in IV form for initiation of steroid
therapy, although PO form theoretically equally
efficacious.
• Two forms: . equal in potency,
• time of onset, and
• adverse effects.
• Inhaled corticosteroids probably equally efficacious
and have fewer adverse effects.
• Adult Dose 125 mg IV q6h recommended dose
Alternative: 1-2 mg/kg IV q6h; not to exceed 125 mg;
this dose often used in children

27. Oxygen therapy
• Benefits of oxygen therapy in advanced COPD include:
– longer survival,
– reduced hospitalization needs, and
– better quality of life.
• Benefits are directly proportionate to the number of hours per day
oxygen is administered.
• Oxygen should be first humidified since dry oxygen causes drying of
respiratory mucosa.
• Oxygen is given through:
– Liquid oxygen systems (LOX),
– Compressed gas cylinders, or
– Oxygen concentrators.

28. Antibiotics
• Antibiotics are commonly prescribed to outpatients with COPD for
the following indications:
(1) to treat an acute exacerbation,
(2) to treat acute bronchitis, and
(3) to prevent acute exacerbations of chronic bronchitis
(prophylactic antibiotics-may not be useful though).
Patients with change in the quantity or character of sputum
benefit the most from antibiotic therapy.
Trimethoprim-sulfamethoxazole (160/800 mg every 12 hours),
Amoxicillin or amoxicillin-clavulanate (500 mg every 8 hours),
Doxycycline (100 mg every 12 hours) given for 7–10 days.

31. http://www.nhlbi.nih.gov/health/health-topics/topics/copd/treatment.html

32. COPD Vs Asthma
• COPD is generally a more serious disease than
asthma, because the changes in the airways are
much more difficult to treat, and it usually has a
worse outcome.
• Unfortunately, COPD can cause greater long-term
disability and have a greater effect on the heart
and other organ systems than asthma.
It should be realized that asthma and COPD can
coexist. If one has asthma and smokes cigarettes for
years, it would not be unusual for him to develop
COPD. In this case, both COPD and asthma coexist.

33. Chief Complaint:
Shortness of breath
COPD Vs Asthma?

34. Chief Complaint: Shortness of breath
Differential diagnosis

35. Cough

36. Cough
• Cough is a natural response of the body to rid itself of
unwanted materials in the airway.
• It occurs through the stimulation of a complex reflex.
• Cough receptors exist not only in the epithelium of the upper
and lower respiratory tracts, but also in the pericardium,
esophagus, diaphragm, and stomach.
• Mechanical cough receptors can be stimulated by triggers
such as touch or displacement.
• Chemical receptors are sensitive to noxious gases or fumes.
• Laryngeal and tracheo-bronchial receptors respond to both
mechanical and chemical stimuli.
Sex-related differences in cough reflex sensitivity explain the
observation that women are more likely than men to develop
chronic cough.

37. Forced
expiratory
volume (FEV)
measures how
much air a
person can
exhale during a
forced breath.
Medical Research
Council dyspnoea
scale

38. Medical Research Council dyspnoea
scale
Medical Research Council dyspnoea scale for grading the degree of a
patient's breathlessness
1. Not troubled by breathlessness except on strenuous exercise
2. Short of breath when hurrying or walking up a slight hill
3. Walks slower than contemporaries on the level because of breathlessness,
or has to stop for breath when walking at own pace
4. Stops for breath after about 100 m or after a few minutes on the level
5. Too breathless to leave the house, or breathless when dressing or
undressing (1)
This scale does not measure breathlessness itself, but the disability caused by
breathlessness (1).
Reference:
• (1) Stenton C. The MRC breathlessness scale. Occup Med (Lond). 2008;58(3):226-7

39. www.medipuzzle.com

40. That’s All
ENJOY
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