COPD

G lobal Initiative for Chronic

O bstructive
L ung
D isease
2015 By Dr. Ratcharoek
CAT
Pharmaco-therapy in COPD:
bronchodilators
Oral medication:
Theophylline, beta-2
agonist (Neulin , Ventolin)
Inhale short acting
bronchodilator:
Anticholinergic: ipratropium
Beta-2 agonist: terbutaline ,
salbutamal (Ventolin MDI)
Anticholinergic + Beta-2 agonist :
Ipratropium bromide +
fenoterol (Berodual MDI)
Inhale Long acting
bronchodilator:
Anticholinergic(LAMA): tiotropium
(Spiriva)
Beta-2 agonist (LABA): salmeterol,
formoterol, indacaterol
 Smoke 20 pack year,
Age 35-40 yr Exposure to RF Occupational exposure ,
Pollution (Indoor/Outdoor)

Airway inflammation Airflow limitation & Air trapping

Bronchoconstriction , mucus , emphysema

Exacerbations ACOS Spirometry

Post BD FEV1/FVC < 0.7
Most common cause
No BD reversibility
infection
High risk : Symptoms
2 exacerbations Shortness of breath, chronic cough , sputum
in last 12 mo
FEV1 < 50%
Deconditioning Inactivity

Exercise capacity

Disability Dz. progression Death

 Anti-inflammation Avoid Smoke,
ICS/LABA
Exposure to RF Occupational exposure ,
Roflumilast Pollution (Indoor/Outdoor)

Airway inflammation Airflow limitation & Air trapping

Bronchodilators
Long short acting
Exacerbation : , vaccine , Combination montherapy
LongExacerbations
acting BD ICS , Roflumolast Inhale-BD oral
Theophylline low efficacy &
Vaccine
more side effect
Assess severity
Management Symptoms
Respi. Support Shortness of breath, chronic cough , sputum ICS + ICS +
O2 SpO2 88- LABA LABA
92% or
LAMA LAMA
NIV Deconditioning Inactivity Theodur
Invasive MV SABA LABA
or
Pharmacological Pulmonary Rehabilitation & SAMA
or
BD LAMA
Physical activity prn
Corticosteroids :
pred 40 mg/d x 5d
ATB 5-10 d Exercise capacity

Disability Dz. progression Death

 Assess severity
/ / PR >120 bpm PEFR < 100 LPM
accessory respiratory muscle paradoxical abdominal motion
Cyanosis SpO2< 90% PaO2< 60 mmHg O2
Arterial pH < 7.35 , PaCO2 > 50 mmHg Rt.side HF

Oxygen Bronchodilators* Corticosteroids Antibiotics

O2 Ipratropium 0.25- Dexamethasone
ATB
CXR 0.5mg + Fenoterol 5mg iv q 6hr

SpO2 88-92% ( Salbutamol) NB Prednisolone po S.pneumoniae ,
CBC
q 4-6 hr H.influenzae ,
Sputum G/S ,
Add Salbutamol M.catarrhalis ,
C/S
2.5-5 mg K.pneumoniae
ECG
terbutaline 5-10 mg


NB as needed q 1-2 hr
MDI + spacer

D/C


Home medication inhaled / ICU
prednisolone 40 bronchodilators accessory

4 RA respiratory muscle assisted
mg
5 SpO2 90% ** 24 paradoxical abdominal ventilation


motion NIV
SpO2 < 90 % PaO2

*

< 50 mmHg O2

adverse reaction Arterial pH < 7.35
 Blood eosinophil guided prednisolone
therapy for exacerbations of COPD

n Recently we showed that patients with a peripheral blood

eosinophil count of 2% at the onset of an outpatient
managed exacerbation respond promptly and completely
to prednisolone, whereas those with a count of <2% had
a higher rate of treatment failure compared with placebo.

n Whether these findings can be replicated in a larger

population, including patients hospitalised with
exacerbations of COPD remains unclear.
 Thank you
For your attention