Rt for Decision-Makers in Respiratory Care May 2008

RT for Decision Makers in Respiratory Care

RX for COPD

Craig Rosebrock, MD, and James Donohue, MD

RT for Decision Makers in Respiratory Care

Chronic Obstructive Pulmonary Disease (COPD) is an inflammatory-linked condition associated with airflow limitations to the lung tissue of a patient. Numerous disease states can be linked to the condition including asthma, bronchitis, emphysema and triggers associated with the presence of inflammatory inhalants. Epidemiologically, the strongest causative factor in COPD globally is cigarette smoke (Lopez, 2006). The authors present the prescription pharmacological factors associated with COPD treatment focusing on clinical pharmacology, clinical data and meta-analysis data to demonstrate treatment options and effectiveness. The primary recommendation for COPD management is cessation of smoking and avoidance of tobacco and nuisance particles. Following a discussion of smoking cessation, the authors discuss the types and use of pharmacotherapy in treating COPD.

Table 1 within the publication describes the recommendations for managing COPD with pharmacological approaches. The diagnosis depends on the determination of the Forced Expiratory Volume in 1 second or FEV1 divided by the Forced Vital Capacity or FVC.

STEPWISE APPROACH TO THE PHARMACOLOGIC Management OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE AND THE POSITION OF BRONCHODILATORS

Severity Spirometric Findings Pharmacologic Intervention

Stage I: mild FEV1/FVC

Stage II FEV1/FVC

Stage III: FEV1/FVC

Stage IV: FEV1/FVC

Following is a list of clinically approved drug therapies for the treatment of COPD symptoms:

Bronchodilators which are used to relax the smooth muscle pathways of pulmonary tissue.

2-adrenergic agonists which bind to receptors on cel surfaces and are used to improve symptoms associated with mucus clearance. The authors show that research on clinical effectiveness has been published primarily for single dose studies and the significance of mucus clearance is not completely verified.

Short-acting ?2-agonists are drugs with a rapid onset of action and are the primary drug used in rescue inhalers. The clinically approved ?2-agonists are albuterol, pirbuterol, and terbutaline. Clinical significance for these drugs is in the use of rescue and rapid onset and little effectiveness is shown for these drugs in long-term treatment.

The long-acting beta agonists, Salmeterol and formoterol have been shown to sustain lung function over extended periods. Clinical effectiveness shows improved lung function and better quality of life for patients, however the triggers of rapid onset COPD can still require faster acting agonist treatment.