|Written by Dr.Md.Redwanul Huq (Masum)|
|Monday, 20 June 2011 15:33|
[HINTS: Contd-To be continued, M- Month, ±M- Before or After Meal, AM- After Meal, ½HBM- ½ Hour Before Meal,W- Week, D-Day.2HAM- 2 Hour After Meal,bid-Twice daily, tid-Three times daily,qid-Four times daily.]
Treatment for stable COPD:
I) Advice to stop smoking
II) Drug treatment:
- a) Short-acting beta2 -agonist bronchodilator (e.g. salbutamol, terbutaline) inhaler- 200 mcg (2 puffs) at a time when required, up to 4-6 times per day. OR, Anti cholinergic drugs, e.g. Ipratropium bromide inhaler.
- b) Combination of both of the above mentioned drugs
- c) (b) + LABA(Long-acting beta2 -agonists, e.g. Salmeterol,Bambuterol or Formoterol) bronchodilator inhaler
- d) (c) + ICS (Inhaled corticosteroids, e.g. Beclomethasone or Budesonide).
III) Supplementary therapy: low conc. (2 – 3 L / min) intermittent O2 inhalation for > 19 hrs / day including sleeping time with ventimax.
IV) Surgical treatment:
- Bullectomy – if the bulla covers >30% of hemi thorax.
- LVRS (Lung volume Reduction Surgery).
- Lung transplantation.
Treatment for acute exacerbation of COPD:
Immediate treatment of COPD:
1.Position: Propped up position of the patient
2.Oxygen: low conc. (2 – 3 L / min) intermittent O2 inhalation for > 19 hrs / day including sleeping time with ventimax
3.Nebulization: Respiratory solution ofshort-acting beta2-agonist bronchodilator (e.g. salbutamol, terbutaline etc) with(if needed) or withoutIpratropium bromide are given stat by nebulizer
4.Antibiotic(s): Antibiotics should be given if there is respiratory infection
5.Parenteral or Oral Steroids: Inj. Hydrocortisone 200 mg IV or Oral Prednisolone 30-60 mg stat.
Subsequent treatment of COPD:
If patient improves:
1. Low concentrations of oxygen should be continued until cyanosis persists or blood gas analysis shows normal levels
2.Nebulization should be reduced- 4 hourly, 6 hourly, 8 hourly, 12 hourly and then inhalers should be started
3. Inj. Hydrocortisone 200 mg IV should be reduced- 6 hourly, 8 hourly, 12 hourly and then oral prednisolone should be started at a dose of 30 – 45 mg od in the morning for 5 – 10 days, then the lowest dose required to control symptoms (usually 7.5-10 mg od in the morning) should be continued if necessary.
If patient does not improve:
1. Low concentrations of oxygen should be continued
2. Nebulization should be repeated after 30 minutes and continued hourly until patient improves
3.Assisted Ventilation may be needed.
4. Management of complications – if present.