Management of COPD
Management of COPD
Introduction
COPD-
RISK FACTORS
Cigarette
Smoking
Respiratory
Infections: Exacerbations
Occupational
Antitrypsin Deficiency
SNP
of MMP12
PATHOPHYSIOLOGY
Airflow
Obstruction: Reduced
FEV1, FVC and FEV1/FVC ratio.
Hyperinflation:
A. air trapping
-increased residual volume and
increased RV/TLC
B. progressive
hyperinflation- increased TLC
Gas
Exchange: Nonuniform
ventilation and ventilation-
PATHOLOGY
Large
Lung
CLINICAL FEATURES
Cough
Sputum
production
Exertional
dyspnea
LABORATORY FINDINGS
Airflow
FEV1/FVC)-prognostic factor
Recent
Severity
Symptoms
Spirometry
At Risk
Normal
Mild
II
Moderate
III
Severe
IV
Very Severe
TREATMENT
Stable
Phase COPD
1. Smoking cessation
2. Bronchodilators- Anticholinergic and long acting -agonist
Reduce
Therapies:
Lung
Lung
transplantation
Rx of COPD exacerbations
Episodes
The
Precipitating
infections.
Chronic
5. Mechanical ventilation:
Noninvasive
positive-pressure ventilation
(NIPPV) in patients with respiratory failure
(PaCO2 >45 mmHg) results in a significant
reduction in mortality rate.
Invasive
Anti-inflammatory
Antioxidant
drugs
therapy
Antiprotease
Regenerative
therapy
therapy
Mucoregulators
Newer
Smoking
Bronchodilators:
Ultra-LAMA-
Dexpirronium
Ultra-LABA-
Novel
Anti-inflammatory drugs
PDE-4
PDE7A
Cytokine
Chemokine
Anti-inflammatory drugs
TGF-
Nuclear
PPAR
Anti-inflammatory drugs
LTB4
Chemokine
Anti-inflammatory drugs
TNF-
Anti-inflammatory drugs
Adhesion
Anti-inflammatory actions.
Anti-inflammatory drugs
Phosphoinositide-3
Macrolide
- Also inhibit the activation of nuclear factor (NF)kB and reverses steroid resistance by increasing
HDAC2 activity.
- Clinical trials of non-antibiotic macrolides are
currently underway.
Antioxidant therapy
Antioxidants-
Antioxidant therapy
iNOS
Resveratrol-
Antiprotease therapy
Endogenous
Protease
inhibitors:
Regenerative therapy
Stem
Retinoic
Mucoregulators
Mucus
Mucus
Theophyline,