Metered Dose Inhaler

Uses an aerosol canister to produce a fine mist of medication

Puffers & autoinhalers
types of MDI
Puffers
Type of MDI that requires good coordination.
Press down on the canister and breathe in at the same time
Autoinhalers
Type of MDI that as you breathe in, your breath activates the device ; problem
of coordination is reduced
Spacer
4- to 8-inch length of tubing or chamber into which you fire your medication
from a puffer and inhale through a mouthpiece
Spacer
Device in which more medication is directed to the lungs; requires less
coordination and can prevent oral thrush
Dry powder inhalers
Require a deep inhalation to get the medication into the lungs; Difficult to use
for young children and adults who have SOB
Turbuhaler
A deep inhaled breath is required to get the medication into the lungs
Symbicort
Example of drug that uses turbuhaler
Aerolizer
Contains powdered medication in a capsule
Nebulizer
Convert liquid medication into a fine mist to be inhaled; May be used if a
puffer and spacer are not suitable
True
T or F: A puffer + spacer are equally as effective as nebulizer
B agonist

The preferred treatment for children

Montelukast & cromolyn
Other options in treatment of asthma in children
1 month to 6 weeks
Treatment of corticosteroids might be given for a trial period of ________
True
T or F: Inhaled corticosteroids can possibly slow the growth of children of all
ages
Calcium and Vit D pills
Management of adults that may develop weak bones from using inhaled
corticosteroids
Preeclampsia & Premature birth of low birth weight
Poor asthma control during pregnancy can cause (2)

COPD
Set of lung diseases that limit air flow and not fully reversible even with
medications
Usually progressive and associated with inflammation of the lungs
True
T or F: COPD is [reventable by avoiding precipitating factors
True
T or F: Symptomatic treatment for COPD is available and more common in
men than women
Emphysema
Permanent abnormal enlargement of the air sacs distal to the terminal
bronchiole with destruction of alveolar septa and attachments to the bronchial walls
Breakdown of elastin by proteases
Destruction of alveolar septa in COPD is caused by
Chronic bronchitis
Excessive tracheobronchial mucus production; Inflammation of major and
small airways
At least 3 months of the year for 2 consecutive years
In chronic bronchitis, conditions is sufficient to cause cough with
expectoration for most days of ______
Smoking
Primary risk factor for COPD
Oxidative stress
Elastin breakdown
Chemoattractant
Decrease ciliary function
Hypertrophy and hyperplasia of mucus secreting glands
DNA damage
Effects of smoking
Air pollution
A cause of COPD where pollutants promotes mucus hypersecretion, airway
inflammation, may cause infection

Occupation
A cause of COPD where exposure to organic and inorganic dust or noxious
gases caused accelerated decline in lung function
Infection
A major factor associated with etiology as well as progression of disease (eg.
Pneumonia) in COPD
a1-antitrypsin deficiency
Genetic factor that can cause COPD
Global Initiative for Chronic Obstructive Lung Disease
Meaning of GOLD
0
Stage of GOLD - AT RISK of COPD
I
Stage for mild COPD accdng to GOLD
II
Stage for moderate COPD accdng to GOLD
III
Stage for severe COPD accdng to GOLD
IV
Stage of very severe COPD accdng to GOLD
STAGE I
Characterized by mild airflow limitation
STAGE I
( FEV1> 80%, FEV1/FVC < 70%)
STAGE I
Stage where symptoms of chronic cough and sputum production may be
present, but not always
STAGE II
characterized by worsening air flow limitation
STAGE II
(50% < FEV1 < 80%; FEV1/FVC <70%)

STAGE II
With shortness of breath, typically developing on effort, cough and sputum
production are also present.
STAGE III
characterized by further worsening air flow limitation
STAGE III
(30% < FEV1 < 50%; FEV1/FVC < 70%)
STAGE III
Greater shortness of breath, reduce exercise capacity, fatigue and repeated
exacerbation that almost always have an impact on patients quality of life
STAGE IV
Characterized by sever air flow limitation
STAGE IV
(FEV1 < 30% or FEV1 < 50% plus the presence of chronic respiratory failure;
FEV1/FVC < 70%)
STAGE IV
At this stage, quality of life is very appreciably impaired and exacerbation
may be life threatening
True
T or F: Patient may have stage IV, very severe COPD even if the FEV1 > 30%,
whenever this complications are present
False
T or F: COPD can be managed and cured
True
T or F: Pharmacotherapy can prevent and control symptoms of COPD
True
T or F: Pharmacotherapy can reduce frequency and severity of exacerbations
of COPD
True
T or F: Pharmacotherapy can improve health status and quality of life of COPD
patients
Influenza vaccination

For active reduction of risk factors for COPD

Influenza vaccination & SABA
GOLD therapy needed in all stages of COPD
LABA & pulmonary rehabilitation
GOLD Therapy needed for Stages II-IV of COPD
Inhaled corticosteroids
GOLD therapy needed if repeated exacerbations for Stages III-IV
Long term oxygen & consider surgery
GOLD therapy if chronic respiratory failure or Stage IV
Short acting bronchodilator as needed
As symptoms become apparent and FEV1 declines, patients should start using
a ____
Long acting bronchodilator
When as needed use of short-acting bronchodilators becomes regular
(every 6 hours), _____ should be initiated with continued as needed short-acting
bronchodilators
Inhaled corticosteroids
For further progression, the use of long-acting beta2-agonists, long-acting
anticholinergics, and _____ are recommended
Pulmonary rehabilitation & oxygen therapy
Supplemental therapy for COPD includes
Corticosteroids
Mainstay treatment for COPD
Corticosteroids
Control bronchospasm
Relieve dyspnea due to airway obstruction
Increase mucociliary clearance by stimulating ciliary activity
Albuterol Levalbuterol Pirbuterol
Short acting B-agonist treatment for COPD
Ipratropium
Short acting anticholinergic bronchodilator treatment for COPD

Salmeterol Formoterol Arformoterol

Long acting B-agonist for COPD
Tiotropium
Long acting B-agonist for COPD
Salmeterol(250) + Fluticasone(50)
Formoterol(160) + Budesonide(4.5)
Combination drug options for COPD
Anticholinergics
Inhibits contraction of bronchial smooth muscle
Reduces the volume of sputum without altering its viscosity
True
T or F: Anticholinergics are most often administered through metered-dose
inhalers, or "puffers
Ipratropium bromide
Glycopyrrolate
Tiotropium
Drugs under anticholinergics for COPD
Theophylline
Added to drug regimen after an unsuccessful trial of ipratropium bromide and
B2-agonists
Theophylline
MOA of this drug are:
Enhance diaphragmatic contractility
Increase mucociliary clearance
Stimulate the respiratory drive (bronchodilator)
Corticosteroids
Added to the drug regimen after maximal ipratropium bromide and B2agonist therapy; to reduce airway inflammation
Inhaled steroids
Add ______ to inhaled bronchodilator in patients with severe COPD and
frequent exacerbations

False
T or F: ICS monotherapy can also be for COPD rather than asthma only
ANTIBIOTICS
Used to treat bacterial infection as evidenced by an increase in volume or
change in color or viscosity of the sputum
Dyspnea Sputum Volume & Purulence
Antibiotics are useful to COPD pateints if there is an increase in any of these
3 symptoms
Co-Amoxiclav
Most commonly used antibiotic for COPD
Mucolytics
May improve sputum clearance and disrupt mucus plugs
Acetylcysteine
Mucolytic drug used in COPD
Expectorants
May be used, but the evidence of effectiveness is anecdotal
Guaifenesin
Glyceryl guiacolate
Terpin hydrate
Iodine products
Expectorants that may be used in COPD
Oxygen therapy
For very severe COPD; if used more than 15 hrs per day, shows increase in
survival
Oxygen therapy
Used as long term continuous therapy, during exercise or to relieve acute
dyspnea
Influenza vaccine
Given annually to patients with COPD
Pneumococcal vaccine
Given to All patients > 65 yo with COPD

False
T or F: Pneumococcal vaccine cannot be given to anyone >65 yo or if smokers