Chronic Obstructive Pulmonary Disease (COPD)
Pharmacy Outreach Program The University of Rhode Island College of Pharmacy
WHAT IS COPD?
Group of lung diseases that interfere with breathing Two most important disease states of COPD are: - Chronic Bronchitis - Emphysema Can also coexist with asthma
Statistics
Approximately 15 million U.S. citizens currently with COPD COPD is the 4th leading cause of death in the U.S. 2.75 million deaths worldwide in 2000 32 billion dollars spent on COPD treatment in 2002 Most commonly diagnosed in older men, however the population of women smokers is increasing therefore the incidence of COPD is increasing for women
Chronic Bronchitis
Inflammatory disease that begins in the smaller airways of the lungs and continues to the larger airways of the lungs
Increased infections in bronchiole tubes Obstructed airflow Increased mucus production Can lead to blueness of lips and skin (cyanosis)
Emphysema ď Ź
Chronic lung disease that affects the alveoli (air sacs) and or bronchi (breathing tubes): -Decreased flexibility of
lung -Expanded lung (barrel chest) -Airways collapse -Obstruction of airflow lead to shortness of breath
Risk Factors for COPD?
Long-term smoking is the #1 cause of COPD -Accounts for 85-90% of COPD -10X more likely to die from COPD Family History (genetics) Second-hand smoke Air pollution at work and in the environment History of childhood respiratory infections
Signs and Symptoms
Chronic cough and sputum Chest tightness Shortness of breath Impaired breathing Increased mucus production Frequent clearing of the throat Cyanosis (bluish tone to lips and skin) Swelling of the feet
Reduce Risk Stop
smoking!
Avoid environmental irritants: -Polluted air -Second hand smoke -Car fumes
Prevent complications of COPD if already diagnosed
Complications of COPD Infections Pulmonary
Hypertension Acute Respiratory Failure Stroke
Smoking Cessation
STOP SMOKING!! Prolongs survival of patients with COPD Rate of lung tissue disease progression returns to a non smoking state over time, but lung function that is lost is not returned Cessation Aids: Chantix, Nicotine replacement therapy (gum, lozenge, etc.)
Treatment of COPD
Anticholinergics Atrovent® (ipatropium bromide) Spiriva® (tiotropium) Most commonly used, first line treatment Dilates the bronchioles (prevent constriction) Helps lungs relax and open Helps breathing
Beta Agonists Most commonly used Dilates the bronchioles, helps clear mucus which helps breathing Come in many different formulations and types of inhalers Some side effects are nervous or shaky feelings, excitement or hyperactivity, increased heart rate, upset stomach (rare), or trouble sleeping (rare)
NEVER USE LONG ACTING FORMS TO HELP ACUTE SYMPTOMS!!!!!!!!!
Treatment of COPD
Combination Products
Combivent® Ipratropium Bromide and Albuterol Advair Diskus® Fluticasone Propionate and Salmeterol Inhalation Powder DuoNeb® Ipratropium Bromide and Albuterol
Anti-inflammatory agents
Theophylline Mucolytics
Inflammation may be present with COPD Decrease inflammation Steroids are available in tablet, IV and inhaled forms Given when the anticholinergics or Beta agonists are not enough
Guaifenesis, n-acetylcysteine
Oxygen Surgery/Transplant
Proper Inhaler Use (aerosol)
Remove cap from mouthpiece of inhaler Shake inhaler 5 – 10 seconds If first use, prime inhaler by spraying twice into the air Place inhaler in mouth with tongue and teeth out of the way Begin to inhale as you press the inhaler Inhale slowly for 5 to 6 seconds, this will help medication reach the lungs At end of inhalation hold breath for 10 seconds Exhale through nose
If more than one puff is required wait a few minutes before the second dose Then repeat the steps again After the last puff be sure to rinse your mouth (especially with steroid inhalers -ex. Flovent®, Advair®) Rinse the mouth piece of inhaler with warm water at least once a day
Pharmacy Outreach Program The University of Rhode Island College of Pharmacy 1-800-215-9001