The Science Journal of the American Association for Respiratory Care

1996 OPEN FORUM Abstracts

Pharmacotherapy of COPD

Irwin Ziment, MD Sunday, November 3, 1996

The steps to be taken in COPD management include:

1. Lifestyle management * Optimize weight, exercise, sleep, etc. * Quit smoking (e.g., use nicotine therapy), avoid adverse exposure * Adjust diet, e.g., adequate fluids, spices, anti-oxidants

2. Treat symptoms * Initially, for intermittent dyspnea, use ß_{2}-agonist p.r.n. * For established disease, base therapy on ipratropium 2-6 puffs q6-8 h., regularly * Add p.r.n. ß_{2}-agonist aerosol * Consider use of salmeterol b.i.d. or h.s. * Add theophylline if response is suboptimal; aim for serum concentration around 10 mg/ml

3. Treat exacerbations * Antibiotics usually help * Increase ipratropium ± ß_{2}-agonist (or combination)-consider continuous * aerosolization for a few hours * Aminophylline drip may help * Steroids help in 1/3 of patients-and may be of value in chronic therapy; aerosol usually not effective

4. Adjuncts * Choose optimal aerosol delivery mode and reservoir * Mucokinetic therapy, e.g., iodides, NAC, GG * Oxygen-do not overuse or prescribe without considering clinical, psychologic and social factors * Psychoactive therapy, e.g., anxiolytics, antidepressants * Respiratory stimulant, e.g., methylphenidate 10 mg t.i.d.

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