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COPD TREATMENT (BRONCHODILATORS (METHYLXANTHINES (EXAMPLE: Theophylline…

- - - - As required
      - EXAMPLE: Salbutamol
      - EXAMPLE: Terbutaline
        
        Brand: Bricanyl
    - - FEV1 MORE THAN 50%
      - EXAMPLE: Salmeterol
      - EXAMPLE: Formoterol
    - - G-Protein Coupled Receptor
        
        cAMP Phosphorylates PKA
        
        Relaxation of bronchial
        smooth muscle
        
        cAMP-independent actions on ion channels
        
        Stimulus-independent
        
        cAMP-mediated
  - - - As required
      - EXAMPLE: Ipratropium
        
        Brand name: Atrovent
    - - EXAMPLE: Tiotropium
      - FEV1 MORE THAN 50%
      - FEV1 LESS THAN 50%
    - - Prevent Ach Binding to Muscarinic Receptors
        
        Relaxation of bronchial
        smooth muscle
        
        Inhibition of bronchial mucus secretion
  - - - Oral
      - Plasma-theophylline concentration
        
        Ideal: 10 - 20 mg/L
        
        INCREASED by
        
        Heart failure
        
        Viral infections
        
        Elderly
        
        Hepatic impairment
        
        CYP1A2 Inhibitors
        
        DECREASED by
        
        Smoking
        
        Alcohol
        
        CYP1A2 Inducers
    - - Oral or IV Infusion
    - - Narrow therapeutic window
      - Metabolism
        
        Liver - CYP1A2
    - - Inhibition of cyclic nucleotide phosphodiesterase (PDE)
        
        Relaxation of bronchial
        smooth muscle
        
        Stimulus-independent
        
        Non-selective
      - Possible anti-inflammatory actions
  - - - FEV1 LESS THAN 50%
        
        ALTERNATIVE: LABA + LAMA
      - EXAMPLE: Symbicort
        
        Formoterol fumarate + Budesonide
      - EXAMPLE:Seretide
        
        Salmeterol + Fluticasone propionate
- - - - Prevent oral candidiasis
- - - - Oxygen cylinder
        
        2 L/min
      - Oxygen concentrators
        
        Oxygen for > 8 hours per day
  - - - Admin. for at least 15 hours a day
      - Prolongs survival in some patients
      - Patients require assessment
    - - Patients on LTOT
        
        Away from home
    - - Improve exercise capacity and recovery
      - Severe COPD
        
        Episodes of breathlessness not relieved by other treatment