COPD

Overlap of Clinical Syndromes

Emphysema

Chronic Bronchitis

Asthma

Alveolar wall destruction, overinflation

Reversible obstruction

Productive cough, airway inflammation

Main cause is cigarette smoke

Small airway fibrosis

Alveolar destruction

Key differences between asthma and COPD: stimulus, involved antibody and immune cells, clinical course, and treatment.

Changes caused by COPD

Airway obstruction

Inflammation

Structural changes

Muco-ciliary dysfunction

Smooth muscle contraction

Increased cholinergic tone

Bronchial hyperreactivity

Loss of elastic recoil

Increased numbers/activation: neutrophils, macrophages, CD8+ T-cells

Elevated IL-8, TNFa, LTB4

Protease/anti-protease imbalance

Mucosal oedema

Alveolar destruction

Epithelial hyperplasia

Glandular hypertrophy

Goblet cell hyperplasia

Collagen deposition

Airway fibrosis

Mucus hyper-secretion

Increased mucus viscosity

Reduced much-ciliary transport

Mucosal damage

Treatment of COPD

All

Mild

Moderate

Severe

Very Severe

Avoidance of risk factors

Influenza vaccine annually

Pneumococcal polysaccharide vaccine

Treatment of complications

Short-acting bronchodilator when needed

Regular treatment with one or more bronchodialators

Rehabilitation

Regular treatment with one or more bronchodilator

Inhaled corticosteroids for patients with repeated exacerbation or persistent symptoms despite bronchodilator therapy

Rehabilitation

Regular treatment with one ore ore bronchodilators

Inhaled corticosteroids if symptoms persist despite bronchodilator therapy

Rehabilitation

Long term O2 therapy if chronic respiratory failure

Surgical treatments considered

Other Pharmacotherapies in COPD

Theophylline

Mucolytics

Multiple PD properties but overall effect is bronchodialtion

Multiple side effects - notably increased HR

Not used as first line therapy as inhaled BA are better bronchodilators and ICSs have better anti-inflammatory properties

Used as an add-on in COPD

Multiple PD properties: overall, decreases mucous viscosity, anti-inflammatory, antioxidant, and antibacterial

Shown to decrease # of exacerbations when added to COPD treatment