Rt for Decision-Makers in Respiratory Care May 2008 Article Review

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<70%; FEV1?80% Add a short-acting bronchodilator to be used when needed; anticholinergic or ss2-adrenoceptor agonist Stage II FEV1/FVC<70%; 50%?FEV1<80% Add one or more long-acting bronchodilators on a scheduled basis. Consider pulmonary rehabilitation. Stage III: FEV1/FVC<70%; 30%?FEV1<50% Add inhaled steroids if repeated exacerbations. Stage IV: FEV1/FVC<70%; FEV1<30% Evaluate for adding oxygen. Consider surgical options. 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….....