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Chronic obstructive pulmonary disease (COPD)- preventable, treatable, but…

- - - - inflammatory cells, neutrophils, macrophages, and lymphocytes, attract other inflammatory mediators (leukotrienes) and proinflammatory cytokines
      - peripheral airways become obstructed- air is progressively trapped during exhalation
        
        Barrel shape
        
        alveoli destroyed
        
        bullae- large air spaces in parenchyma
        
        significant ventilation-perfusion (V/Q) mismatch
        
        hypoxemia results
        
        blebs- air spaces adjacent to pleurae
      - excess mucus production caused by increased number of mucus secreting globlet cells , enlarged submucosal glands, dysfunction of cilia, and stimulation in inflammatory mediators
        
        result in productive cough
- - - - causes polycythemia
        
        increased viscosity of the blood
        
        increases pulmonary hypertension
        
        increase of red blood cells
        
        increases risk of clotting
  - - - enlargement of RV
      - leads to right sided heart faliure
- - - - ipratropium (Atrovent HFA)
        
        Nebulizer, MDI
    - - aclidinium bromide (Tudorza, Pressair)
        
        DPI
      - revefenacin (Yupelri)
        
        Nebulizer
      - tiotropium (Spiriva HandiHaler)
      - umeclidinium (Incruse Ellipta)
  - - - arformoterol (Brovana)
        
        Nebulizer
      - formoterol (Foradil Aerolizer, Perforomist)
        
        DPI, nebulizer
      - indacaterol (Arcapta Neohaler)
      - olodaterol (Striverdi Respimat)
        
        MDI
      - salmeterol (Serevent Diskus)
        
        DPI
    - - albuterol (Proventil HFA, Ventolin HFA, Proair HFA, AccuNeb, CoSpire ER[oral only])
        
        Nebulizer, MDI, oral
      - levalbuterol (Xopenex, Xopenex HFA)
        
        Nebulizer, MDI
  - - - IV
    - - Oral
  - - - MDI
    - - DPI
  - - - motelukast (Singulair)
        
        Chewable tablets, oral granules
      - zafirlukast (Accolate)
        
        Oral tablets
    - - zileuton (Zyflo, Zylfo CR)
  - - - Oral Tablets
    - - IV
  - - - omalizumab (Xolair)
        
        subQ
    - - mepolizumab (Nucala)
      - reslizumab (Cinqair)
        
        IV
  - - - oral
  - - - ipratropium/albuterol (Combivent Respimat, DuoNeb)
        
        inhaler spray (Combivent Respimat)
        
        Nebulizer (DuoNeb)
    - - mometasone furoate/formoterol fumarate (Dulera)
        
        MDI
      - fluticasone/salmeterol (Advair Diskus or HFA)
      - fluticasone/vilanterol (Breo Ellipta)
        
        DPI
      - budesonide/formoterol (Symbicort)
    - - umeclidinium/vilanterol (Anoro Ellipta)