Chronic Obstructive Pulmonary Disease (COPD) (cont.)
Sat Sharma, MD, FRCPC, FCCP
Ryland P Byrd Jr, MD
Francisco Talavera, PharmD, PhD
Zab Mosenifar, MD
IN THIS ARTICLE
Corticosteroids are used for people who do not improve sufficiently after trying other drugs or who develop an exacerbation.
Oral steroids have been used successfully to treat acute exacerbations. They improve symptoms and lung function in this circumstance. Oral corticosteroids are generally not recommended for long-term use because of their potential side effects.
In people with COPD, chronic infection of the lower airways is common. The goal of antibiotic therapy is not to eliminate organisms but to treat acute exacerbations.
This therapy is most beneficial for people whose exacerbations are characterized by at least 2 of the following (ie, Winnipeg criteria): increased shortness of breath, increased sputum production, and increased sputum purulence.
Mucolytic agents not only reduce sputum viscosity (resistance to its flow) but also improve sputum clearance.
Breo Ellipta is also a combination of the inhaled corticosteroid and fluticasone furoate as well as the long-acting beta2 agonist, vilanterol. Breo Ellipta is an inhaled long-term, once-daily maintenance treatment of airflow obstruction in patients with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and/or emphysema. It is also indicated to reduce exacerbations of COPD in patients with a history of exacerbations.
COPD is commonly associated with worsening oxygenation of the blood (hypoxemia).
Many people with COPD who are not hypoxemic at rest have worsening of their blood oxygen level during exertion. Even though studies to determine the long-term benefit of oxygen solely for exercise have not yet been conducted, home supplemental oxygen is commonly recommended for people whose blood oxygen level falls with exercise. Oxygen supplementation during exercise can prevent increases in pulmonary artery pressure, reduce shortness of breath, and improve exercise tolerance.
Oxygen therapy for people with COPD may be needed during air travel because of low airplane cabin pressure. If flying, you should arrange supplemental oxygen prior to the flight directly through the airline or through an airline agent (at an extra expense).
Supplemental oxygen may also be needed for people with COPD whose sleep is disturbed by its symptoms.
Oxygen therapy is generally safe. Toxicity from high concentrations of oxygen is well recognized, but little is known about the long-term effects of low concentrations of supplemental oxygen. Because providing oxygen reduces the death rate of people with advanced COPD, the increased survival and quality of life benefits of long-term oxygen therapy outweigh the possible risks.
The major physical hazards of oxygen therapy are fires or explosions. People with COPD, their family members, and their caregivers are warned not to smoke when supplemental oxygen is in use. Overall, major accidents are rare and can be avoided by proper training.
Oxygen delivery systems
Long-term oxygen therapy (LTOT) is typically delivered by continuous flow nasal cannula. This method is the standard means of oxygen delivery because it is simple, reliable, and generally well tolerated. At home, a machine called an oxygen concentrator is the usual means through which oxygen is delivered. Portable tanks provide the opportunity for people with COPD to continue their oxygen therapy while away from home.
Oxygen-conserving devices enable the use of smaller, lighter, and more portable oxygen tanks. Oxygen-conserving devices function by delivering all of the supplemental oxygen during early inhalation (breathing in). In addition, they may reduce overall costs.
Three oxygen-conserving devices exist: reservoir cannulas, demand pulse delivery devices, and transtracheal oxygen delivery. Transtracheal oxygen delivery is invasive and requires special training by you, your health care provider, and your caregiver.
Progressive airflow obstruction may impair oxygenation and/or ventilation to the point where you may require assisted ventilation.
General guidelines that are used in determining the ideal time to begin ventilatory support are as follows:
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