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.