Ebook ABC of COPD (2/E): Part 2
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Ebook ABC of COPD (2/E): Part 2
CHAPTER 7Pharmacological Management (I) -Inhaled TreatmentGraeme p. Currie' and Brian J. Lipworth21Aberdeen Royal Infirmary. Aberdeen. UK2Asthma and A Ebook ABC of COPD (2/E): Part 2Allergy Research Group. Ninewells Hospital and Medical School. I hinder. UKOVERVIEW•All patients with chronic obstructive pulmonary dsease (CCPD) should use a short-acting bronchodilator {short-acting p?-agonst Of short-acting anticholinergic) for as required relief of symptoms. A long-acting bronch Ebook ABC of COPD (2/E): Part 2odilator (long-acting anticholinergic or long-acting h?-agonist) should be started in those with persistent symptoms and exacerbations if the FEV| csEbook ABC of COPD (2/E): Part 2
>so% of predicted•Inhaled corticosteroids play no role as monotherapy in CO?D•A long acting JV-agonist plus mha'ed corticosteroid or long acting anticCHAPTER 7Pharmacological Management (I) -Inhaled TreatmentGraeme p. Currie' and Brian J. Lipworth21Aberdeen Royal Infirmary. Aberdeen. UK2Asthma and A Ebook ABC of COPD (2/E): Part 2, kxig-acting b.'-agnoist and rhaed corticosteroid should be used in patients with advanced disease who have persistent symptoms and exacerbationsChronic obstructive pulmonary disease (COPD) isa heterogeneous condition and all patients should be regarded as individuals. This is apparent not only in Ebook ABC of COPD (2/E): Part 2terms of presentation, natural history, symptoms, disability and frequency of exacerbations but also in response to treatment. The stepwise titrationEbook ABC of COPD (2/E): Part 2
of pharmacological therapy in COPD is usually based around•extent of airflow obstruction;•severity of symptoms (usually breathlessness);•functional liCHAPTER 7Pharmacological Management (I) -Inhaled TreatmentGraeme p. Currie' and Brian J. Lipworth21Aberdeen Royal Infirmary. Aberdeen. UK2Asthma and A Ebook ABC of COPD (2/E): Part 2tors confer important clinical benefits over and above changes in forced expiratory volume in 1 second (FEV|). Relying upon measures of lung function alone to monitor the effects of bronchodilators may be a rather simplistic approach, and has the potential to miss important physiological and clinica Ebook ABC of COPD (2/E): Part 2l benefits. Air trapping, whichABC df COPD. 2nd edition.Edited by Graeme p. Currie. £12011 UlackwcU Pubishing Ltd.I----------------------Patents sMthCEbook ABC of COPD (2/E): Part 2
OFOFigure 7.1 Patients with chrome obstructs pulmonary disease (GOTO) have pu'monary hyperinflation with an increased functional residual capacity (puCHAPTER 7Pharmacological Management (I) -Inhaled TreatmentGraeme p. Currie' and Brian J. Lipworth21Aberdeen Royal Infirmary. Aberdeen. UK2Asthma and A Ebook ABC of COPD (2/E): Part 2of respiration at mechanical disadvantage Hyperinflation worsens with exerase and therefore reduces exercise tolerance (dynamic hyperinflation), Inhated bronchodilators improre dynamic hyperinflation, m addition to hyperinflation at rest, thereby reducing the work of breathing and increasing exerase Ebook ABC of COPD (2/E): Part 2 tolerance.is manifested clinically as hyperinflation, is frequently found in patients with advanced COPD; this places the respiratory musclesat a mecEbook ABC of COPD (2/E): Part 2
hanical disadvantage. During exercise, air trapping increases even further, which in turn perpetuates the mechanical disadvantage experienced at rest CHAPTER 7Pharmacological Management (I) -Inhaled TreatmentGraeme p. Currie' and Brian J. Lipworth21Aberdeen Royal Infirmary. Aberdeen. UK2Asthma and A Ebook ABC of COPD (2/E): Part 2r without significant changes in FEV|. Moreover, as COPD is largely an irreversible condition, relying solely on outcome measures such as lung function may result in potentially important beneficial effects being missed upon parameters such as static lung volumes, quality of life and exacerbation fr Ebook ABC of COPD (2/E): Part 2equency.Short-acting bronchodilatorsShort-acting p>-agonists such as salbutamol and terbutaline act directly upon bronchial smooth muscle to dilate thEbook ABC of COPD (2/E): Part 2
e airway32Pharmacobgkal ManagTable 7.1 Pharmacological properties of the main inhaled bronchodilators used n COPDClassDrugOnset (minutes)Peak effect (CHAPTER 7Pharmacological Management (I) -Inhaled TreatmentGraeme p. Currie' and Brian J. Lipworth21Aberdeen Royal Infirmary. Aberdeen. UK2Asthma and A Ebook ABC of COPD (2/E): Part 212Short-acting antrcholnergĩcIpratropium4506160-12045022leng-actmg anuchdiinergKTmtropium1560-24036CHAPTER 7Pharmacological Management (I) -Inhaled TreatmentGraeme p. Currie' and Brian J. Lipworth21Aberdeen Royal Infirmary. Aberdeen. UK2Asthma and AGọi ngay
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