COPD 2.0.0-1.pptx. How to characterize and manage COPD

COPD and it's management

1. COPD (CHRONIC OBSTRUCTIVE PULMONARY DISEASE)

2. Destruction of bronchi, lung parenchyma and alveoli. Aetiology Repeated inhalation of dust, fumes, cigarette smoke Risk factors Age, Gender, occupation Genetic factors deficiency of alpha 1 antitrypsin (AAT) which inhibits neutrophil elastase (breaks down elastin in lungs resulting in loss of lung elastic recoil results from damage to elastic fibers and loss of alveolar surface area.)

3. Pathophysiology of COPD   Pathophysiologic feature of COPD is airflow limitation caused by airway narrowing (bronchitis) and/or obstruction, loss of elastic recoil (emphysema)

4. DIFFERENCES BETWEEN ASTHMA AND COPD ASTHMA Has an early onset No fibrosis in lung tissue Infrequent production of sputum Not related to smoking Mostly due to allergies Clinical symptoms are intermittent and variable Stable COPD Occurs later in life Fibrosis in lung tissue Frequent production of sputum Mostly in patients that smoke COPD occurring due to allergies is infrequent Clinical symptoms are persistent Progressively worsens

5. Bronchitis Primary cause is smoking. It triggers inflammation due to irritation of the airways. Causes lymphocytes, macrophages and neutrophils to release cytokines. This amplifies inflammatory response resulting in increased mucus production, fibrosis and bronchospasms. This results into narrowed airways air trapping and hyper inflated lungs .

6. Characterized by: Cough with sputum for most days for up to 3 months for 2 consecutive years Hypertrophy of goblet cells in bronchi Increased number of goblet cells Increased mucus production Inflamed bronchi with production of pus Irreversible fibrosis

7. Emphysema Due to smoking and alpha 1 anti trypsin deficiency Smoking – inflammation – neutrophils – elastase -destruction of elastin tissues Manifestation Productive cough Dyspnea Wheezing Chest tightness Cyanosis Frequent respiratory infections

8. Complications Infections e.g., pneumonia Respiratory failure due to acute exacerbation of COPD Co- pulmonale pulmonary hypertension due to increase resistance to blood flow. Causes an increased afterload  Polycythemia Elevated RBC levels due to hypoxia Pneumothorax air in the pleural cavity Hypoxia Hypercapnia

9. DIAGNOSIS Chest x rays, Spirometry, ECG, ABG MANAGEMENT Goals Decrease mortality and morbidity Reduce exacerbations Improve quality of life Prevent complications Non pharmacological management Cessation of smoking Patient education

10. PATIENT EDUCATION Cessation of smoking Avoid triggers Be adherent to their medication What to do incase of an acute attack Explain how to use an inhaler

11. There are three major types of inhalers. These are Metered dose inhalers Dry powder inhalers Soft mist inhalers Turbuhaler Accuhaler Ellipta MDI MDI with spacer

12. If it is the first time using the inhaler they should prime Afterwards they should rinse their mouth with water

13. Pharmacological management 1. Bronchodilators Short-acting bronchodilators (SABAs and SAMAs): Used for quick relief of symptoms. Examples: SABAs (Short-Acting Beta-Agonists): Albuterol. · Inhaler: 2 puffs every 4-6 hours for acute bronchospasm, or before exercise. · Nebulizer: 2.5 mg for adults (0.63-1.25 mg for children) 3-4 times daily. · Oral Tablets: 2-4 mg every 6-8 hours for adults, lower for children. · Oral Syrup: 2-4 mg every 6-8 hours for adults, based on weight for children.

14. SAMAs (Short-Acting Muscarinic Antagonists): Ipratropium. · Inhaler: 2 inhalations four times daily (max 12 puffs per day). · Nebulizer: 500 mcg (0.5 mg) three to four times daily. · Nasal Spray: 2 sprays per nostril, 2-4 times daily depending on the concentration

15. Long-acting bronchodilators (LABAs and LAMAs): Used regularly to control symptoms. Examples: LABAs (Long-Acting Beta-Agonists): Salmeterol , For COPD (Adults): 50 mcg (1 puff) twice daily, approximately 12 hours apart. Formoterol . For COPD (Adults): 12 mcg (1 puff) twice daily, approximately 12 hours apart. The dosage may be adjusted depending on the severity of the condition

16. LAMAs (Long-Acting Muscarinic Antagonists): Tiotropium , For COPD (Adults): 18 mcg (1puff) once daily using the dry powder inhaler. 2.5 mcg (2 puffs of 1.25 mcg each) once daily using the soft mist inhaler. Aclidinium , For COPD (Adults): 400 mcg (1 puff) twice daily, approximately 12 hours apart. Glycopyrronium . For COPD (Adults): 50 mcg (1 puff) once daily.

17. 2 . Inhaled Corticosteroids (ICS) Purpose: Reduce inflammation in the airways and are often combined with long-acting bronchodilators in more severe cases. Examples: Fluticasone, For COPD: Adults: 100-250 mcg (1-2 puffs) twice daily. Maximum dose: Up to 500 mcg twice daily, depending on the severity of the condition.

18. Budesonide. For COPD: Adults: 200-400 mcg (1-2 inhalations) twice daily. Maximum dose: Up to 800 mcg twice daily, depending on the severity of the condition. Nebulizer Solution: For COPD (Adults and children 12 years and older): 0.5 mg via nebulization twice daily. Maximum dose: Up to 1 mg twice daily, based on the severity of the condition.

19. 3. Systemic corticosteroids Purpose: reduce inflammation and further exacerbations Examples: prednisone, methylprednisolone Dosages: prednisone 30-40mg OD orally for 5-7 days methylprednisolone 40-125mg OD IV for 5-7 days

20. 4. Methylxanthines Example: Theophylline Purpose: Bronchodilation: Theophylline helps relax the muscles around the airways, making breathing easier. Anti-inflammatory Effects: It also has mild anti-inflammatory properties. Dosage: Oral Theophylline: Initial Dose: 200-400 mg once daily (extended-release) Maintenance Dose: Typically 400-900 mg daily, divided into doses every 12 hours. Therapeutic Range: 5-15 mcg/mL (blood levels should be monitored to avoid toxicity).

21. 5. Combination Inhalers Triple therapy inhalers: Combine a LABA, a LAMA, and an ICS in a single inhaler for patients with more advanced COPD or frequent exacerbations. Examples: Trelegy Ellipta fluticasone For COPD: Adults: 100-250 mcg (1-2puffs) twice daily. Maximum dose: Up to 500 mcg twice daily, based on severity. umeclidinium For COPD (Adults): 62.5 mcg (1puff) once daily.

22. vilanterol For COPD (Adults): 22 mcg (1 puff) once daily. 6 . Phosphodiesterase-4 (PDE4) Inhibitors Purpose: Reduce inflammation and relax the airways in severe COPD with chronic bronchitis. Example: Roflumilast . For COPD (Adults): 500 mcg (1 tablet) once daily.

23. Management of acute exacerbation attacks Assess Severity Oxygen Therapy Administer Short-Acting β2- Agonists (SABA) Administer Short-Acting Muscarinic Antagonists (SAMA) Administer Systemic Corticosteroids Administer Antibiotics . E.g., doxycycline 100mg BD *7/7-14/7 , azithromycin 500mg OD*3/7 Non-invasive Ventilation (NIV) Patient Education and Discharge Planning Hospitalization. That is, in patients with severe exacerbatio n

24. Prevention of future exacerbations Patient education Vaccinations Long term maintenance therapy Pulmonary ventilation

25. Contraindications 1.SABA Severe cardiac conditions: Use cautiously in patients with arrhythmias, severe hypertension, or ischemic heart disease. 2.SAMA Narrow-angle glaucoma, Bladder neck obstruction, Prostatic hyperplasia 3. LABA Severe cardiac disorders: Similar to SABA 4. Inhaled Corticosteroids (ICS) Active systemic infections Untreated fungal, bacterial, or viral infections of the respiratory tract 5. Systemic Corticosteroids Systemic fungal infections, Peptic ulcer disease, Uncontrolled diabetes Osteoporosis 6. Methylxanthines Severe cardiac arrhythmias, Peptic ulcer disease, Seizure disorders 7. Phosphodiesterase-4 Inhibitors moderate to severe hepatic impairment, History of depression with suicidal ideation

26. Side effects SABAs Tremors Nervousness Tachycardia (increased heart rate) Palpitations Headache Hypokalemia (low potassium levels) SAMAs Dry mouth Bitter taste Constipation Urinary retention (rare) LABAs Muscle cramps Headache Palpitations Tremors Increased risk of cardiovascular events (rare) ICS Oral thrush (candidiasis) Hoarseness (dysphonia) Sore throat Increased risk of pneumonia Bruising and thinning of the skin (with long-term use) Adrenal suppression (rare with high doses) Phosphodiesterase-4 Nausea Diarrhea Weight loss Headache Insomnia Depression and suicidal thoughts (rare but serious)

27. continued……… Systemic corticosteroids Hyperglycemia Fluid retention and edema Increased appetite and weight gain GI disturbances Increased risk of infections due to long term use Skin thinning and easy bruising Methylxanthines GI disturbances Tachycardia and arrhythmias Headaches Insomnia Tremors Seizures (at toxic levels) Antibiotics Azithromycin QT prolongation resulting in arrhythmias Ototoxicity 2. Doxycycline Photosensitivity Teeth discoloration

28. THE END