Chronic obstructive pulmonary disease, or COPD, is the fourth leading cause of death among adults between the ages of 65 and 84 in the United States, according to the Murray and Nadel's Textbook of Respiratory Medicine. It is a chronic disease manifested by an obstructive pattern of breathing which results in incomplete emptying of the lungs during expiration, and hyperinflated lungs result. Often, the condition is marked by acute exacerbations superimposed on the chronic condition which can become quite dangerous. Common causes of exacerbations include infections, congestive heart failure, blood clots in the lungs or environmental toxins.
Bronchodilators
Bronchodilators are a mainstay of COPD exacerbation treatment. These medications function by dilating the bronchioles in the lungs, which decreases the resistance in the airways to air outflow. In the case of COPD exacerbation, only fast-acting bronchodilators such as albuterol are used; they are also known as "rescue" or quick relief medications.
Corticosteroids
Corticosteroids are normally occurring hormones that are produced in the adrenal glands. They can also be exogenously ingested for a wide variety of medical conditions, COPD exacerbations included. Their main mechanism of action is to decrease the inflammation in the airways which is a typical hallmark of COPD. As a result, swelling and mucus production in the airways decreases, which decreases the resistance to airflow out of the lungs. Typically, patients on chronic COPD therapy are already on an inhaled corticosteroid but are switched to oral medications during exacerbations; examples include prednisone and methylprednisolone.
Antibiotics
Infection is the number one cause of COPD exacerbation, and thus antibiotics are a mainstay of therapy. The most common pathogens involved are Streptococcus pneumonia, Haemophilus influenza and Moraxella catarrhalis. Antibiotic therapy is aimed at these organisms and includes doxycycline, amoxicillin-clavulanate and trimethoprim-sulfamethoxazole. More sever exacerbations warrant more powerful drugs such as ceftriaxone or medications from the aminoglycoside (gentamicin) or fluroquinolone (ciprofloxacin) classes of antibiotics.
Oxygen
Since the primary problem associated with COPD exacerbation is a problem with oxygenation, supplemental oxygen is often the first treatment initiated. It can range from a simple cannula placed in the nostril to noninvasive ventilation such as the CPAP mask, to invasive ventilation through a breathing tube placed in the trachea, depending on the severity of the exacerbation. The noninvasive and invasive methods of delivering oxygen to the lungs decrease the work done by the breathing muscles and lets the medical therapies work so that regular breathing can resume thereafter.
Additional Therapy
Diuretics and nitrate medications are often given if congestive heart failure is thought to be the cause of COPD exacerbation. Congestive heart failure can result in fluid buildup in the lungs, which is removed by the diuretics. The nitrates are indicated for dilation of the blood vessels in the body, which results in decreased work load for the heart which can stop or decrease the fluid buildup in the lungs as it pumps the blood forwards (not letting it back up into the lungs).
References
- "Murray and Nadel's Textbook of Respiratory Medicine, 4th Edition;" Mason; 2005
- Archives of Internal Medicine; "Corticosteroid therapy for patients with acute exacerbations of chronic obstructive pulmonary disease;" Singh, JM et al. Volume 162, 2002.
- American Family Physician; "COPD: Management of Acute Exacerbations and Chronic Stable Disease;" Hunter, M et al. Volume 64, August 2001.
