DR Medhat MRCP

2. Bronchodilator therapy
A short-acting beta2-agoinst (SABA){salbutamol} or short-acting muscarinic
antagonist (SAMA)(ibratropium) is first-line treatment
For patients who remain breathless or have exacerbations despite using shortacting
bronchodilators the next step is determined by the FEV1
FEV1 > 50% FEV1 < 50%
- (LABA), e.g salmeterol - LABA + inh. Steroid in a combination inhaler (seritide)
or
or
- (LAMA), e.g tiotropium - LAMA
For patients with persistent exacerbations or breathlessness
- If taking a LABA switch to a LABA + Inh. steroids combination inhaler
- Otherwise give a LAMA and a LABA + ICS combination inhaler
Oral theophylline
- NICE only recommends theophylline after trials of short and long-acting
bronchodilators or to people who cannot used inhaled therapy.
- Dose if co-prescribed with macrolids or quinolones.
The role of inhaled steroids in TTT of COPD is to decrease
the frequency of exacerbation, ↓ stay in the hospital & it
سؤال doesn`t improve long term prognosis
3. Mucolytics
- Should be 'considered' in patients with a chronic productive cough and
continued if symptoms improve
4. Loop diuretics ± LTOT in Cor pulmonale
- Features include peripheral oedema, raised jugular venous pressure,
systolic parasternal heave, loud P2
- Use a loop diuretic for oedema, consider long-term oxygen therapy (LTOT)
- ACE-inhibitors, calcium channel blockers and alpha blockers are not
recommended by NICE
سؤال هام
5. Long –term oxygen therapy (LTOT)
Indications in COPD (dose 1-2 L/min with addetional 1 L during exercise &
sleeping) :
1- FEVI < 30% (i.e very severe COPD)
2- Daytime PO2 30% of the time).