COPD

PHARMACOlogic
treatment
 GLUCOCORTICOIDS
It is a therapeutic therapy for disease
associated with airway inflammation like
COPD and asthma
Shown less impressive benefits on COPD than
asthma
Only 10% show subjective benefit and an increase
in FEV1 by at least 20%
 GLUCOCORTICOIDS
Oral glucocorticoids
For acute, chronic and severe exacerbations
40 to 60 mg of prednisone daily for 5 days
Chronic use have been associated with significant
side effects including osteoporosis, weight gain,
cataracts, glucose intolerance, and increased risk
of infection
 GLUCOCORTICOIDS
Inhaled glucocorticoids
Should be considered with patients with frequent
exacerbations (2 or more per year)
*Exacerbations are commonly considered to be episodes of increased
dyspnea and cough and change in the amount and character of
sputum.

1600 g/ day
Reduce exacerbation frequency by ~25%
May also reduce mortality by ~25%
 GLUCOCORTICOIDS
Inhaled glucocorticoids
Beclomethasone diplopionate (BECLOVENT, VANCERIL)
Triamacinolone actonide (AZMACORT)
Flunisolide (AEROBID)
Budesonide (PULMICORT)
Fluticasone propionate (FLOVENT)
 GLUCOCORTICOIDS

Inhaled glucocorticoid

Side effect
Their use has been associated with increased rates
of oropharyngeal candidiasis and an increased
rate of loss of bone density
In inflammation
release from the damaged tissue cells of chemical substances
that activate the inflammation process chemicals such as
histamine, bradykinin, proteolytic enzymes, prostaglandins,
and leukotrienes
increase in blood flow in the inflamed area caused by some of
the released products from the tissues, an effect called
erythema
leakage of large quantities of almost pure plasma out of the
capillaries into the damaged areas because of increased
capillary permeability,
infiltration of the area by leukocytes
 GLUCOCORTICOIDS
Anti-inflammatory action

1. Stabilizes the lysosomal membrane

- most of the proteolytic enzymes that are released by
damaged cells that cause inflammation are mainly
stored in the lysosomes
2. Decreases both migration of WBCs into the
inflamed area and phagocytosis of damaged
cells
- diminishing formation of prostaglandins
and leukotrienes
 GLUCOCORTICOIDS
Anti-inflammatory action
3. Suppresses the immune system, causing
lymphocyte reproduction to decrease markedly

**Attenuates fever by reducing the release of

interleukin-1 from the white blood cells