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Chronic obstructive pulmonary disease (COPD) is a chronic airway condition that is manageable but has the potential to cause severe medical and financial challenges. Its effective management is, therefore, paramount. This is done through adherence to the proven guidelines of management, such as the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria that classify and recommend an effective treatment for each patient group (Fuchs et al., 2018). Additionally, it is essential to consider treatment situations in various special groups such as pediatrics, geriatrics, pregnant and lactating women.
COPD is a chronic lung disease that affects the pulmonary. It is characterized by persistent respiratory symptoms and limitation in the flow of air through the respiratory system due to abnormalities in both the alveoli and the airway itself (Kim, 2017). The chronic limitation of airflow results from disease of the small airways referred to as obstructive bronchiolitis and parenchymal destruction, known as emphysema (Kim, 2017). The condition is characterized by a stable stage and exacerbations.
The management of patients with COPD is based on patient grading that is done using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria that classifies patients into four groups, A to D. This classification is based on spirometry results of tests carried out on patients. The recommendations of the criteria are aimed at reducing symptoms and reducing risks in COPD patients. Treatment mainly focuses on the management of stable COPD and the management of exacerbations in a two-pronged approach.
The key medications used in the management of COPD are bronchodilators. These are the short-acting beta-adrenergic such as albuterol (Proair HFA), short-acting antimuscarinics such as ipratropium (Atrovent HFA), and long-acting beta-adrenergic such as formoterol (Foradil). The other group of medications used in COPD is inhaled corticosteroids such as budesonide (Pulmicort flexhaler). The patients are maintained on either one of or a combination of these drugs based on their classification into the GOLD grade criteria algorithm. Exacerbations are classified as either mild, moderate, or severe. Mild exacerbations are managed using short-acting beta-agonists only; moderate exacerbations are handled using a combination of short-acting beta-agonists, antibiotics, and/or oral corticosteroids, while acute exacerbations are managed using the same methods as moderate exacerbations in addition to hospitalization.
Patients that are on medications for the management of COPD require regular monitoring of the adverse effects of the medications. Patients prescribed beta-adrenergic drugs are monitored by checking for the development of tremors, nervousness, and palpitations during treatment. Patients on theophylline are monitored through the measurement of blood levels of the drug and checking for headaches, restlessness, and palpitations on history. Patients on corticosteroids are followed up by a physical examination to rule out oral and esophageal candida, measurement of blood sugar, measurement of ACTH levels, and regular bone profile tests.
Patients should, therefore, be advised when receiving a prescription for such medication. Patients on beta-adrenergic drugs need to be made aware of the increased risk of tremors, anxiety, and palpitations. Those on theophylline should be advised to avoid caffeine-containing products and strictly adhere to their prescriptions. Patients on these two drugs must initially have cardiac disease ruled out. Patients on corticosteroids should be advised on the risk of developing oral candida and trained on the proper use of inhaled corticosteroids, including rinsing the mouth after use. They should also be informed of the risk of adrenal insufficiency.
There are special groups of patients to be considered when treating COPD, and treatment should be tailored to individual needs (Woodruff, Agusti, Roche, Singh & Martinez, 2015). In geriatrics, there is a risk of polypharmacy and drug interactions in addition to the presence of other comorbidities such as cardiac conditions. These should be considered to prevent poor outcomes. In pediatrics, weight is a vital consideration in prescribing medication, and the rate of drug metabolism is higher than in adults. Additionally, corticosteroids are used cautiously to prevent adversely affecting the growing skeleton. In pregnancy and lactation, beta-agonists that are selective to the airway are used to avoid inducing labor. While prescribing to lactating mothers, it is crucial to consider the excretion of drugs in breastmilk and avoid those that undergo this process.
References
Fuchs, F., Singh, D., Bjermer, L., Abrahams, R., Grönke, L., Voss, F., & Ferguson, G. (2018). Classifying patients as GOLD A-D using the 2017 strategy criteria: Impact on efficacy by GOLD stage in the OTEMTO tiotropium+olodaterol clinical trials. Pneumologie, 72(S 01), S90-S91. Web.
Kim, E. (2017). Pathophysiology of COPD. COPD, 57-63. Web.
Woodruff, P., Agusti, A., Roche, N., Singh, D., & Martinez, F. (2015). Current concepts in targeting chronic obstructive pulmonary disease pharmacotherapy: Making progress towards personalized management. The Lancet, 385(9979), 1789-1798. Web.
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