1. Pharmacotherapy Of
COPD
Presented By
Ms. Pranali A. Chandurkar
Assistant Professor
Department of Pharmacology
Dr. Rajendra Gode Institute of Pharmacy, Amravati.

2. Chronic Obstructive Pulmonary Disease
(COPD)
• Also called as Chronic Obstructive Airway Disease.
• COPD is characterized by difficulty in exhaling air.
• It is slowly progressive disease and irreversible.
• The most common cause of COPD is Cigarette Smoking.
• COPD may include diseases that cause airflow obstruction (eg.,
Emphysema, Chronic Bronchitis) or combination of these disorders.

3. 1)Chronic Bronchitis
• Chronic bronchitis is a chronic inflammation of the lower respiratory tract
characterised by excessive mucous secretion, cough & dyspnea associated with
recurrent infection of the lower respiratory tract.
• The condition is more common in middle-aged males than females i.e.,
approximately 20% adult men and 5% adult women.
Risk Factors :
• Smoking
• Air pollution (Dust, NO2, SO2, toxic fumes etc)
• Genetic factor

5. Pathophysiology

6. Sign And Symptoms
• Cough
• Wheezing
• Shortness of breath
• Chest tightness
• Hypoxemia
• Hypercapnia
• Cyanosis

7. Emphysema (Pink Puffers)
• Emphysema is a form of chronic lung disease which is characterised by the
irreversible enlargement of air spaces.
• The most common cause is tobacco smoking and congenital α1AT deficiency.
• Types :
1) Centriacinar emphysema
2) Pacinar emphysema
3) Paraseptal (Distal acinar) emphysema
4) Irregular emphysema

8. Pathophysiology

9. Sign And Symptoms
• Weight loss
• Dyspnoea
• Cough occur late after dyspnoea start
• Wheezing
• Cough
• Shortness of breath
• Long term mucus production
• Enlarged chest

10. Pharmacotherapy
1) Risk Management :
• Smoking cessation is the single most effective intervention to prevent COPD
or slow its progression.
• It is major essential to reduce disease
• progression and improve survival rate.
• Use nicotine replacement product and
• medication to quit smoking.

11. 2) Bronchodilators :
• Bronchodilators relieve bronchospasm and reduce airway obstruction by allowing
increased oxygen distribution throughout the lungs and improving alveolar
ventilation.
• They are mostly used for the management of COPD, which are delivered through a
metered-dose inhaler (MDI) by nebulization or via oral route.
• Both short acting and long acting bronchodilators are used.
a) Short-acting Bronchodilators : Salbutamol
Ipratropium
b) Long-acting Bronchodilators : Tiotropium
Salmeterol
Formoterol

12. a) Short-acting bronchodilator inhalers
• For most people with COPD, short-acting bronchodilator inhalers are the first treatment used.
• Bronchodilators are medicines that make breathing easier by relaxing and widening your airways.
• There are 2 types of short-acting bronchodilator inhaler:
1) β2 agonist inhalers : Salbutamol and Terbutaline
2) Antimuscarinic inhalers : Ipratropium
• Short-acting inhalers should be used when you feel breathless, up to a maximum of 4 times a day.
Salbutamol
• It is highly selective B2 agonist
• Produces bronchodilation within 5 min by relaxing the bronchiolar smooth muscle.
• Action last for 2-4 hrs.
• Side effects : Muscle tremor, Palpitation, Restlessness, Nervousness, Throat irritation, Ankle edema
• Dose : 100-200 ug by inhalation

13. Ipratropium bromide
• It is a short acting inhaled anticholinergic bronchodilator.
• It blocks the bronchoconstriction mainly in the larger airways.
• Action last for 4-6 hrs
• Inhaled anticholinergics are the bronchodilator of choice in COPD.
Combination of Salbutamol and Ipratropium
• DUOLIN INHALER : 100 ug + 20 ug per metered dose
• DUOLIN ROTACAP : 200 ug + 40 ug per rotacap
• DUOLIN RESPULES : 2.5 mg + 500ug in 2.5 ml solution

14. Long-acting bronchodilator inhalers
• If you experience symptoms regularly throughout the day, a long-acting bronchodilator inhaler will
be recommended.
• These work in a similar way to short-acting bronchodilators, but each dose lasts for at least 12 hours,
so they only need to be used once or twice a day.
• There are 2 types of long-acting bronchodilator inhaler:
a. β2 agonist inhalers : Salmeterol, Formoterol and Indacaterol
b. Antimuscarinic inhalers : Tiotropium, Glycopyronium and Aclidinium
Salmeterol
• It is the first long acting selective B2 agonist with slow onset of action.
• Long acting B2 agonist are superior to short acting ones and equivalent to inhaled anticholinergic in
COPD.
• They reduces breathlessness by preventing expiratory closure of peripheral airways and abolishing
the reversible components of airway obstruction.
• Dose : Salmeterol 25 ug per metered dose inhaler; 2 puffs BD; severe cases 4 puffs BD

15. Formoterol
• It is a long-acting selective B2 agonist
• Action last for 12 hrs
• In comparison to Salmeterol, it has faster onset of action
• Dose : 12-24 ug by inhalation twice daily.
Tiotropium Bromide
• It is a long acting inhaled anticholinergic bronchodilator.
• Action last for 24 hrs.
• Tiotropium is more effective than ipratropium in COPD.
• Regular maintenance therapy with long acting anticholinergic
inhalationcan reduces the episode of COPD exacerbations.

16. New Drugs :
• Indacaterol, Olodaterol, Vilanterol are new ultra long acting selective B2
agonist that have been approved for maintenance treatment of COPD.
• They are administered by inhalation in powder form ( Indacaterol, Vilanterol)
or solution form (Olodaterol) once a day.
• Side effects: Cough
Dizziness
Nasopharyngitis.
• Glycopyrronium Bromide is a long acting anticholinergic drug has been
approved as a maintenance treatment of COPD.
• Dose : 50ug inhalation powder per cap once a day.

17. 3) Methylxanthines :
• Theophylline, Aminophylline
• It decreases release of histamine, other mediators and cytokines from mast cells and
activated inflammatory cells.
• Adverse effects : Theophylline has a narrow margin of safety.
• Headache, nervousness, nausea, dyspepsia, insomnia, convulsions, delirium,shock,
arrhythmias
• Dose : Theophylline 100-300 mg TDS
Aminophylline 100 mg tab, 250 mg/ 10 ml inj.
• Theophylline used in the treatment of chronic COPD improve lung function like
vital capacity and FEV1.
• Theophylline used in patients who are intolerant to inhaled bronchodilators.
• If patients does not achieve optimum clinical response with β2 agonist and
anticholinergic then methylxyanthines are added to the regimen.

18. Roflumilast
• It has been approved by US-FDA for symptomatic treatment of COPD.
• It is a selective PDE4 inhibitors.
• It exerts antiinflammatory action, primarily in the lungs.
• Lung function is improved and risk of exacerbations is reduced.
• Adverse effects : Diarrhoea
weight loss
psychiatric disturbances

19. 4) Corticostroids :
• Glucocorticoids are not broncodilators.
• They benefit by inhibiting inflammatory cytokine production and eosinophilic,
lymphocytic infiltration of lungs.
• They also reduce bronchial hyperreactivity, mucosal edema and suppress inflammatory
response to AG:AB reaction or to other stimuli.
a) Inhaled steroids :
• Fluticasone, Budesonide
• It reduces airway inflammation and help to prevent exacerbations.
Fluticasone :
• Fluticasone propionate is an inhaled glucocorticoid which has high potency, longer
duration of action and negligible oral bioavailability.
• The dose swallowed after inhalation has little propensity to produce systemic effects.
• At high doses, systemic effects may be due to absorption from lungs.

20. b) Systemic corticosteroids :
• The chronic use of oral GCs for the treatment of COPD is not recommended because
of an unfavorable benefit/risk ratio.
• A short course of 1-3 weeks of oral glucocorticoids may benefits in some patients of
COPD during an exacerbations.

21. Combinations of bronchodilators and inhaled steroids
• Fluticasone and vilanterol
• Salmeterol and Fluticasone
• Formoterol and Budesonide
• Fluticasone, umeclidinium and Vilanterol

22. 5) Vaccination :
• All patients with COPD should receive the Influenza vaccine
annually.
• Polyvalent pneumococcal vaccine is also recommended in patients
>65yrs old.

23. 6) Oxygen therapy :
• For more than 15 hrs per day for COPD patients in chronic hypoxia respiratory failure can
increase survival.
• The goal of oxygen therapy should be an oxygen saturation of 88-90%.
7) Surgery :
• Surgical options for treatment of severe COPD include
a) Lung transplantation
b) Bullectomy
c) Lung volume reduction

24. Stage Recommended Treatment
All • Avoidance of risk factors (smoking)
• Influenza vaccine annually
• Pneumococcal vaccine
• Treatment of complications
Mild COPD • Short-acting bronchodilators when needed
Moderate COPD • Regular treatment with one or more bronchodilators
Severe COPD • Regular treatment with one or more bronchodilator
• Inhaled corticosteroids for patients with repeated exacerbation or
persistent symptoms despite bronchodilator therapy
Very severe COPD • Regular treatment with one or more bronchodilator
• Inhaled corticosteroids if symptoms persist despite bronchodilator therapy
• Long term O2 therapy if chronic respiratory failure
• Surgical treatment considered
Drug therapy

25. Thank You…!!
Eliminate tobacco from your life before it
kills you..!!