Lecture 29/30 COPD

Question 1

Non-Pharmacological Options for COPD

Answer 1

smoking cessation, reduce exposure: air pollution, occupational dust, chemicals

writing an action plan

inhaler technique,, Pulmonary Rehab: exercise training, education, behaviour change, designed to improve the physical and psychological condition

exercise

pursed lip breathing

education

vaccinations: influenza, pneumococcal, RSV for older than 60, dTAP, COVID

Oxygen: PaO2 of < 55 mmHg or < 60 mmHg + right sided heart failure or secondary polycythemia improves survival

Question 2

Mucolytics

Answer 2

tx for COPD

N-acetylcysteine (NAC) 600 mg po bid

small reduction in exacerbations without increase in AE

Mech not fully understood

injectable form can be used orally

AE: N/V, stomatitis, rhinorrhea

Question 3

Macrolides for COPD

Answer 3

Azithromycin - 250-500 mg three times weekly or 250 mg daily

reduce number of exacerbations

assess QTc, ototoxicity, antibiotic resistance

drug interactions

AE: GI intolerance, QTc prolongation

Question 4

PDE4 Inhibitors for COPD

Answer 4

Roflumilast - 500 mcg once daily

MOA: inhibition of cAMP breakdown = suppresses release of inflammatory mediators

improvement in FEV1, small reduction in exacerbations

AE: GI - N/V, diarrhea, decreased appetite, weight decrease, ab pain

CNS - H/A, insomnia, anxiety, depression, avoid in pt with hx of depression with suicidal ideation