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