Treatment of chronic obstructive pulmonary disease (COPD).

Treatment of chronic obstructive pulmonary disease(COPD).

Pharmacological and non-pharmacological both treatments are required simultaneously to get better effect from COPD disease condition.

Pharmacological treatment

Note : All medication of COPD are only for adult person who are above 16 years old. The pharmacological treatment are depend on three different stage of COPD patient according to their severity. Basically COPD stage are three types according to severity. They are –

Mild COPD
Moderate COPD
Sever COPD

Mild COPD patient’s treatment

Symptoms

Physical finding

Cough may produce or not
Dyspnea may occurred or not
Sputum production or not

Blood test

Polycythemia
WBC count may increase due to infection.
Arterial blood gas studies

!. PaO2 level may decrease or not ( 45 to 60 mm Hg) !!. PaCO2 level may Increase or not ( 30 to 60 mm Hg) !!!. Decrease arterial pH

Spirometer test

FEV1/FVC < 70%
Increase residual lung volume
Decrease vital capacity (VC)
Decrease FEV1 <80%

Heart function test

a.Tachycardia may shown

Medication

1.1. Short acting β2 agonist

Eg. Albuterol

Dose

Nebulization: 2.5 mg with 3 ml 0.9N NaCl solution three to four times a day, over approximately 5 to 15 minutes by nebulizer machine. DPI: 1 to 2 inhalation each contain 180 mcq orally every 4 to 6 hours. Or

1.2. Short acting anticholinergic

Eg. Ipratropium Dose Nebulization: 500 mcg with 3 ml 0.9N NaCl solution three to four times a day, over approximately 5 to 15 minutes by nebulizer machine. MDI: One or two puff (20 mcg/puff) three or four times a day. Or

1.3. Combination of long acting β2 agonist and Short acting anticholinergic.

Eg. Salbutamol + Ipratropium Dose Nebulization: Salbutamol + Ipratropium (2.5 mg + 500 mcg ) with 3 ml 0.9N NaCl solution three to four times a day, over approximately 5 to 15 minutes by nebulizer machine. MDI: One or two puff {Salbutamol + Ipratropium (20 mcg + 100 mcg )} two or three times a day. Indication: You can take any one of three above medication for 5 to 7 days or when exacerbation occurred. You should take or one or two puff as MDI 30 min before starting exercise. Note: I suggest taking 1.3 no medicine of above should better choice of you.

Moderate COPD patient’s treatment

Symptoms

Physical finding

Cough may produce or not.
Dyspnea occurred slightly.
Sputum production or not.
FEV1/FVC < 70%, It may be reduced to 50%.
FEV1 < 50%.
Decrees concentration

Blood test

Polycythemia
WBC count may increase due to infection.
Arterial blood gas studies

!. PaO2 level may decrease or not ( 45 to 60 mm Hg) !!. PaCO2 level may Increase or not ( 50 to 60 mm Hg)

Spirometer test

FEV1/FVC < 70% It may be near to 50%
Increase residual lung volume
Decrease vital capacity (VC)
Decrease FEV1 <80% or near to 50%

Heart function test

a.Tachycardia may shown

Moderate COPD patient’s medication for treatment

2.1.Short acting β2 agonist

Albuterol

Dose

Nebulization:

2.5 mg with 3 ml 0.9N NaCl solution three to four times a day, over approximately 5 to 15 minutes by nebulizer machine.

DPI: 1 to 2 inhalation each contain 180 mcq orally every 4 to 6 hours. Or

2.2. Short acting anticholinergic

Ipratropium – Dose :

Nebulization: 500 mcg with 3 ml 0.9N NaCl solution three to four times a day, over approximately 5 to 15 minutes by nebulizer machine.
MDI: One or two puff (20 mcg/puff) three or four times a day. Or

2.3. Combination of long acting β2 agonist and Short acting anticholinergic.

Salbutamol + Ipratropium

–Dose:

Nebulization:

-Salbutamol + Ipratropium (2.5 mg + 500 mcg ) with 3 ml 0.9N NaCl solution three to four times a day, over approximately 5 to 15 minutes by nebulizer machine.

MDI: One or two puff {Salbutamol + Ipratropium (20 mcg + 100 mcg )} two or three times a day. Indication: You can take any one of three above medication for 5 to 7 days or when exacerbation occurred. You should take or one or two puff as MDI 30 min before starting exercise.

Note: I suggest taking 2 .3 no medicine of above should better choice of you. If fast line medicine does not work properly you should take second line medicine.

Second line medication:

3.1. Combination of short acting β-agonist (levalbuterol) and long acting anticholinergic (tiotropium).

a. Levalbuterol Dose for adult MDI:

2 puffs every 4 to 6 hours as needed. Nebulization: 0.63 to 1.25 mg with 3 ml 0.9N Nacl every 4 to 6 hours as needed up to 3 doses per 24 hours.

b. Tiotropium Dose for adult

MDI

2 puffs per puff contain 1.25 mcg once a day as needed. Nebulization: 1.25 to 2.5 mcg with 3 ml 0.9N Nacl once per 24 hours.

Note : If combination dose is not available You must take medication a and b individually, 1 nebulization combination solution may use.

Nebulization should take 20 minutes interval for 1 hour and better to take when exacerbation or may take two times a day. Many of the country like Bangladesh this combination or individual medicine is not available. In this case I recommended another combination of medicine that are available. You should use this combination when fast combination or individual medicine is not available.

Use of Medicine:

3.2. combination of Salmeterol + Fluticasone Propionate

I suggest as MDI Doses: {Salmeterol ( 25 mcg) + Fluticasone Propionate(250 mcg)} per puff. Tow puffs two times a day.

3.3. Theophylline

Theophylline dose:

400 mg tablet form twice daily for 15 days to 1 month. You should use combination 3.1 with 3.3 medications simultaneously. If use combination 3.1 with 3.3 medications simultaneously and It could not work well you should add 3.2 medication with 3.1 & 3.3 medicine. When your lung is infected by various bacteria or virus you should use antibiotics with above medicine. It is better to use antibiotics by screening test of various microorganism resistances. Without this screening test you may used antibiotics like –

3.4. Azithromycin

Azithromycin dose

Tablet form of Azithromycin 500 mg once daily for 5 to 7 days. If your first antibiotics Azithromycin does not work well you should add 2^nd antibiotics like levofloxacin with azithromycin.

3.5. Levofloxacin

Levofloxacin dose:

Tablet form levofloxacin 500 mg once daily for 7 days. How can you understand that you should need to take antibiotics???

Physical finding:

Cough may produce.
Dyspnea occurred slightly.
Sputum production.
Decrees concentration

Blood test

WBC count may increase due to infection.

You may also added more medicine when your disease condition is very worse.

3.6. Steroid ( eg. Prednisolone)

Prednisolone dose:

Tablet form of prednisolone 20 mg once or twice a daily.

Adult: 10-60 mg/day

Note: It should be concern about diabetics patient for using of steroid. It will need better for dose reduction.

3.7. Leukotriene Modifiers ( e.g. Montelukast)

Montelukast dose:

Adult: 10 mg/ daily single dose

3.8. Cough exponent ( eg. Ambroxol)

Ambroxol Dose:

Syrup formation 10 ml each time for three times a day. Finally it is important to ensure oxygen supply at least 12 hours per day until development the dyspnea.

Treatment for Sever COPD

Symptoms

Physical finding

Cough may produce.
Dyspnea occurred it may sever.
Sputum production it may also sever.
FEV1/FVC < 50%, It may be reduced to 30%.
FEV1 < 30%.
Decrees concentration
Skin becomes yellowish color due to lacking oxygen supply in the body.
Bluer vision

Blood test

Polycythemia

WBC count may increase due to infection.
Arterial blood gas studies

!. PaO2 level may decrease or not ( 30 to 45 mm Hg) !!. PaCO2 level may Increase or not ( 40 to 70 mm Hg) !!!. Decrease arterial pH seriously.

Spirometer test

FEV1/FVC < 50% It may be near to 30%
Increase residual lung volume
Decrease vital capacity (VC)
Decrease FEV1 <50% or near to 30%

Heart function test

a.Tachycardia may shown

Medication

4.1.Short acting β2 agonist

Eg. Albuterol Dose Nebulization: 2.5 mg with 3 ml 0.9N NaCl solution three to four times a day, over approximately 5 to 15 minutes by nebulizer machine. DPI: 1 to 2 inhalation each contain 180 mcq orally every 4 to 6 hours. Or

4.2. Short acting anticholinergic

Eg. Ipratropium Dose Nebulization:

500 mcg with 3 ml 0.9N NaCl solution three to four times a day, over approximately 5 to 15 minutes by nebulizer machine. MDI: One or two puff (20 mcg/puff) three or four times a day. Or

4.3.Combination of long acting β2 agonist and Short acting anticholinergic.

Eg. Salbutamol + Ipratropium

Dose for Nebulization:

Salbutamol + Ipratropium (2.5 mg + 500 mcg ) with 3 ml 0.9N NaCl solution three to four times a day, over approximately 5 to 15 minutes by nebulizer machine.

MDI:

One or two puff {Salbutamol + Ipratropium (20 mcg + 100 mcg )} two or three times a day. Indication: You can take any one of three above medication for 5 to 7 days or when exacerbation occurred. You should take or one or two puff as MDI 30 min before starting exercise. Note: I suggest taking 4 .3 no medicine of above should better choice of you. If fast line medicine does not work properly you should take second line medicine.

Second line medication:

5.1. Combination of short acting β-agonist (levalbuterol) and long acting anticholinergic (tiotropium).

a. Levalbuterol Dose for adult MDI:

2 puffs every 4 to 6 hours as needed. Nebulization: 0.63 to 1.25 mg with 3 ml 0.9N Nacl every 4 to 6 hours as needed up to 3 doses per 24 hours.

b. Tiotropium

Dose for adult MDI:

2 puffs per puff contain 1.25 mcg once a day as needed.

Nebulization:

1.25 to 2.5 mcg with 3 ml 0.9N Nacl once per 24 hours. Note : If combination dose is not available You must take medication a and b individually, I nebulization combination solution may use. Nebulization should take 20 minutes interval for 1 hour and better to take when exacerbation or may take two times a day. Many of the country like Bangladesh this combination or individual medicine is not available. In this case I recommended another combination of medicine that are available. You should use this combination when fast combination or individual medicine is not available.

Medication:

5.2. combination of Salmeterol + Fluticasone Propionate

I suggest as MDI Doses: {Salmeterol ( 25 mcg) + Fluticasone Propionate(250 mcg)} per puff. Tow puffs two times a day.

5.3. Theophylline

Theophylline dose:

400 mg tablet form twice daily for 15 days to 1 month. You should use combination 5.1 with 5.3 medications simultaneously. If use combination 5.1 with 5.3 medications simultaneously and It could not work well you should add 5.2 medication with 5.1 & 5.3 medicine. When your lung is infected by various bacteria or virus you should use antibiotics with above medicine. It is better to use antibiotics by screening test of various microorganism resistances. Without this screening test you may used antibiotics like –

5.4. Azithromycin Dose:

Tablet form of Azithromycin 500 mg once daily for 5 to 7 days. If your first antibiotics Azithromycin does not work well you should add 2^nd antibiotics like levofloxacin with azithromycin.

5.5. Levofloxacin Dose:

Tablet form levofloxacin 500 mg once daily for 7 days.

How can you understand that you should need to take antibiotics???

Physical finding:

Cough may produce.
Dyspnea occurred slightly.
Sputum production.
Decrees concentration

Blood test

WBC count may increase due to infection.

You may also added more medicine when your disease condition is very worse.

5.6. Steroid ( eg. Prednisolone)

Dose Tablet form of prednisolone 20 mg once or twice a daily.

Adult: 10-60 mg/day

Note: It should be concern about diabetics patient for using of steroid. It will need better for dose reduction.

5.7. Leukotriene Modifiers ( e.g. Montelukast)

Dose

Adult: 10 mg/ daily single dose

5.8. Cough exponent ( eg. Ambroxol)

Dose Syrup formation 10 ml each time for three times a day. Finally it is important to ensure oxygen supply at least 17 hours per day until development the dyspnea. It is better for patient to hospitalized.

Caution

When any COPD patient use above medication you should highly cautious.

Patient should avoid medicine who are:

Chronic kidney patient
Chronic liver disease patient
Heart failure patient
pregnant and lactation patient

Patient should partially cautious to taking medicine no 3.2,3.6 5.4, & 5.6 of above who are:

strong diabetics patient
Mild or moderate diabetics patient not need more cautious.

Patient should partially cautious to taking medicine no 1.2, 1.3, 2.2, 2.3, 3.1, 4.2, 4.3, 5.1 & 5.2 of above who are:

Severe tachycardia patient like pulse rate more then 115 beat per minutes.
Mild or moderate tachycardia patient not need more cautious.

Patient should partially cautious to taking medicine no 3.4 & 5.4 of above who are:

Severe gastric, peptic or duodenum ulcer patient.
Mild or moderate gastric, peptic or duodenum ulcer patient not need more cautious.
Sever gastric, peptic or duodenum ulcer patient may take above medicine with mucus membrane protective medicine like PPI (eg. Omeprazole) or H2 (eg. Famotidine) receptor blocker.

Note: patient with potentially fatal COPD should be quickly identify and aggressively managed Need to hospitalization.

Prevention and treatment of chronic obstructive pulmonary disease ( COPD).

Exercise-induced bronchospasm (EIB )

You can prevent exacerbation Due to exercise By using medication .

1.1, Short acting beta agonist ( eg. Albuterol) Should be administered 15 minutes before exercise.

1.2, long acting beta agonist and formoterol should be administered 30 to 60 mins before exercise.

Concurrent disease

Allergic rhinitis sinusitis and Gastroesophageal Reflux disease (GERD), vocal cord dysfunction and obstructive sleep apnea frequently coexist with asthma. It should be better to management of this concurrent disease by medication with chronic obstructive pulmonary disease treatment.

2.1. For Gastroesophageal Reflux disease Medication should be use such as PPI (eg. esomeprazol, Pantoprazol) or H2 receptor antagonist (eg, Famotidin)

2.2. For allergic rhinitis medication should be used such as antihistamine ( eg. rupatidin. cetirizine)

There are more different factors which may affect chronic obstructive pulmonary disease condition. To prevent COPD we should know well about chronic obstructive pulmonary disease causes and symptoms.

Advice

That foods make COPD you should always avoid that foods and habits.
Avoid allergens ( eg. Pollen, house dust mite, animal dander, mould, cockroach, food)Avoid
Avoid occupational exposure ( eg. chemical irritants, frour , wood, textile dusts.)
Immediate treatment viral respiratory tract infection.
Should control exercise or use medicine before it begun.
Should control your emotions ( eg, anxiety, Stress, hard laughter, crying).
Should avoid exposure to irritants ( eg.Strong orders, chemicals, fumes ).
Should avoid environmental exposure ( weather changes, cold air, Sulphur dioxide, cigarette smoke ).
Should control using drugs like NSAID ( Aspirin, Ibuprofen etc ), Antiadrenergic and cholinergic drugs( eg. beta adrenergic blockers, Botanical).

Note: If you suffer sever COPD attack and don’t control at home you should go hospital immediately.

If anyone want to more information please send to me your question through the given email address.

Email address: mallicktarun@rocketmail.com

For getting treatment base suggestion please contact or request an appointment.