Professional Documents
Culture Documents
Abstract
Chronic obstructive pulmonary disease (COPD) is a progressive lung disease that is associated with airway obstruction.
COPD is a major cause of chronic morbidity and mortality throughout the world. It is a progressive condition, but is partially
reversible through treatment, especially when diagnosed early in its clinical course. Bronchodilators are important in treating
the symptoms of COPD. Long-acting bronchodilators provide sustained symptom relief and are usually preferred in patients
with COPD. Combining bronchodilators with different mechanisms of action appears to improve efficacy.
Medpharm
Introduction
responsiveness.3 Rarely, a genetic condition called alpha1antitrypsin deficiency may play a role in causing COPD.3,5
Symptoms
Initially, in the early stages of COPD, the patient may
experience no symptoms or only mild symptoms.3 However,
as the disease progresses, the symptoms of COPD may
worsen.3 Characteristic symptoms of COPD are a chronic
cough, sputum production and dyspnoea (breathlessness).
The most common early symptom is exertional dyspnoea.
Other symptoms may include chest tightness, wheezing,
fatigue, morning headaches and an increase in respiratory
infections, such as colds and flu.1,3,6,7
Diagnosis
The diagnosis of COPD is based upon the presence of
symptoms associated with COPD, such as a cough with
or without sputum production, dyspnoea at rest or during
exertion, and progressive limitation of activity.The hallmark
for the diagnosis of COPD is spirometry showing airflow
limitation that is incompletely reversible with an inhaled
bronchodilator. 1,3,6
Risk factors
Management
Lifestyle changes
The best method for cigarette smokers to prevent or keep
COPD from worsening is to quit smoking.1,5 Second-hand
smoke, dust, fumes or other toxic substances which may
be inhaled should also be avoided.5
Vol 56 No 1
Side-effects of b2-agonists
Side-effects of b2-agonists are often dose-related. They
include the following:1,10
Tremors
Palpitations
Tachycardia (a rapid heart rate)
Premature ventricular contractions
Hypokalaemia (decreased potassium levels)
Sleep disturbances
Anticholinergics
The most important effect of anticholinergic medication
in patients with COPD appears to be blockage of
acetylcholines effect on the muscarinic receptors.1 They are
able to cause bronchodilation with minimal side-effects and
may be of particular benefit to patients who are not able to
use inhaled b2-agonists.10
Short-acting anticholinergics
The bronchodilating effect of short-acting inhaled
anticholinergics lasts longer than that of short-acting
b2-agonists, with some bronchodilator effect apparent
up to eight hours after administration.1 Short-acting
anticholinergics, e.g. ipratropium, improve lung function
and COPD symptoms. If symptoms are mild and infrequent,
a short-acting anticholinergic may be recommended on an
as-needed basis.4
b2-agonists
The principle action of the b2-agonists is to stimulate b2
adrenergic-receptors, which increase cyclic adenosine
monophosphate
and
functional
antagonism
to
bronchoconstriction. This results in relaxation of the smooth
muscle of the airways.1 b2-agonists can either be short- or
long-acting.1,4,5
Long-acting anticholinergics
Short-acting b2-agonists
Side-effects of anticholinergics
Anticholinergics are poorly absorbed which may limit
troublesome systemic effects.1 The most commonly
reported side-effect of anticholinergeric agents is dryness of
the mouth. Some patients using ipratropium have reported
a bitter metallic taste after inhalation.1,10 An unexpected
small increase in cardiovascular events in patients with
COPD who are regularly treated with ipratopium bromide
has been reported, which requires further investigation.1
Vol 56 No 1
Complications
Methylxanthines
The mechanism that underlies the beneficial effect of the
methylxanthines in treating COPD is not well defined,
but may include an improvement in respiratory muscle
strength.10 However, controversy remains about the exact
effects of the xanthine derivatives.1 Theophylline is the
most commonly used methylxanthine. All studies that have
shown the efficacy of theophylline in COPD were performed
using slow-release preparations.1 Theophylline is not
commonly used, but may be beneficial to some people with
more severe, but stable COPD. The dose of theophylline
must be monitored carefully using blood tests because of
its potential toxic effects.4 Theophylline is less effective and
less well tolerated when compared to inhaled long-acting
bronchodilators, and is not recommended if these agents
are available and affordable.1
Side-effects
Conclusion
References
1.
Global initiative for chronic obstructive lung disease. Global strategy for the diagnosis,
management, and prevention of chronic obstrcutive pulmonary disease. The Global
Initiative for Chronic Obstructive Lung Disease (GOLD) [homepage on the Internet].
2013. Available from: http://www.goldcopd.org
2. Raising awareness of chronic obstructive pulmonary disease. South African COPD
Edu-Group [homepage on the Internet]. c2013. Available from: http://www.copd.co.za
3. Rennard SI. Chronic obstructive pulmonary disease, including emphysema. UpToDate
[homepage on the Internet]. 13 2013. c2013. Available from: http://www.uptodate.
com
4. Rennard SI. Chronic obstructive pulmonary disease treatments. UpToDate [homepage
on the Internet]. 2013. c2013. Available from: http://www.uptodate.com
5. Chronic obstructive pulmonary disease. National Heart, Lung and Blood Institute
[homepage on the Internet]. c2013. Available from: http://www.nhlbi.nih.gov/health/
health-topics/copd
6. Rennard SI. Chronic obstructive pulmonary disease: definition, clinical manifestations,
diagnosis, and staging. UpToDate [homepage on the Internet]. 2013. c2013. Available
from: http://www.uptodate.com
7. Chronic obstructive pulmonary disease: overview. FamilyDoctor.org [homepage on
the Internet]. 2012. Available from: http://www.familydoctor.org/familydoctor/en/
diseases-conditions/chronic-obstructive-pulmonary-disease.html
8. What are bronchodilators? American Thoracic Society [homepage on the Internet].
2013. c2013. Available from: http://www.thoracic.org/clinical/copd-guidelines/forpatients/what-are-bronchodilators.php
9. Chronic obstructive pulmonary disease: medications. WebMD [homepage
on the Internet]. 2011. Available from: http://www.webmd.com/lung/copd/tc/
chronic-obstructive-pulmonary-disease-copd-medications
10. Leader D. A closer look at bronchodilators in treatment of COPD. About.com
[homepage on the Internet]. c2013. Available from: http://www.copd.about.com/od/
emphysema/a/bronchodilators.htm
11. Onbrez Breezhaler package insert. 7 June 2012. Novartis South Africa (Pty) Ltd.
12. Medifocus guidebook on chronic obstructive pulmonary disease. Medifocus
Guidebooks [homepage on theInternet]. 2013. c2013. Available from: http://www.
copd-guidebook.com/2009/landingp.php
Vol 56 No 1