2. СOPD Chronic obstructive pulmonary disease (COPD), a common preventable and treatable disease, is characterized by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lung to noxious particles or gases

3. ETIOLOGYOFСOPD ETIOLOGY OF СOPD Most cases of COPD are the result of exposure to noxious stimuli: Tobacco smoke Indoor air pollution Occupational dust and chemical Outdoor air pollution

4. СOPD Epidemiology. Epidemiology. The Burden of Obstructive Lung Disease study found a global prevalence of 10.1%. Men were found to have a pooled prevalence of 11.8% and women 8.5%. Mortality. Mortality. COPD is the fourth leading cause of death in the United States.

5. СOPD Symptoms of COPD include: Dyspnea Dyspnea Chronic cough Chronic cough Chronic sputum production Chronic sputum production

6. TREATMENT AND PHARMACOTHERAPY OF COPD Bronchodilators (beta 2 agonists, Anticholinergics, Theophylline) Bronchodilators (beta 2 agonists, Anticholinergics, Theophylline) Inhaled Corticosteroids Inhaled Corticosteroids Oral Corticosteroids Oral Corticosteroids Beta-Adrenergic Agonist and Anticholinergic Agent Combinations Beta-Adrenergic Agonist and Anticholinergic Agent Combinations Beta2-Adrenergic Agonist and Corticosteroid Combinations Beta2-Adrenergic Agonist and Corticosteroid Combinations Xanthine Derivative Xanthine Derivative Phosphodiesterase Type 4 (PDE-4) Inhibitors Phosphodiesterase Type 4 (PDE-4) Inhibitors Antibiotics Antibiotics Smoking Cessation Therapies Smoking Cessation Therapies

7. PHARMACOTHERAPY OF COPD Beta2-Adrenergic Agonists, Short-Acting Beta2-Adrenergic Agonists, Short-Acting Albuterol Dosing and Uses: 0.5 mL of 0.5% solution (2.5 mg) nebulized q4- 8hr PRN; inhaler: 2 puffs inhaled PO q4-6hr. Metaproterenol Dosing and Uses: 20 mg PO TID/QID; 0.01 mL/kg up to 0.3 mL 5% solution nebulized q4-6hr; 0.65 mg/puff; inhaler: 2-3 puffs q3-4hr, no more than 12 puffs/day.

8. PHARMACOTHERAPY OF COPD Beta2-Adrenergic Agonists, Short-Acting Beta2-Adrenergic Agonists, Short-Acting Levalbuterol Dosing and Uses: Neb Solution: 0.63-1.25 mg neb TID (q6-8hr); MDI: 2 inh (90 mcg total) q4-6hr. Pirbuterol Pirbuterol Dosing and Uses: 1-2 actuations q4-6hr PRN, no more than 12 actuations/day.

9. PHARMACOTHERAPY OF COPD Beta2-Adrenergic Agonists, Long-Acting Beta2-Adrenergic Agonists, Long-Acting Salmeterol Dosing and Uses: 1 inhalation (50 mcg) BID Formoterol Dosing and Uses: 12 mcg inhaled PO q12hr. Arformoterol Dosing and Uses: 15 mcg inhaled via nebulization BID Indacaterol Dosing and Uses: 75 mcg inhaled orally qDay.

10. PHARMACOTHERAPY OF COPD Anticholinergic Agents Anticholinergic Agents Ipratropium Dosing and Uses: Inhaler: 2 puffs QID, additional puffs PRN; not to exceed 12 puffs/day. Nebulizer: 2.5 mL (500 mcg) 0.02% solution (1 unit dose vial) q6-8hr. Tiotropium Dosing and Uses: 2 oral inhalations of 1 capsule (18 mcg) qD with HandiHaler inhalation device.

11. PHARMACOTHERAPY OF COPD Xanthine Derivative Xanthine Derivative Theophylline Dosing and Uses: Load: 5-7 mg/kg IV/PO; not to exceed 25 mg/min IV. Smoker: 0.79 mg/kg/hr IV infusion for next 12 hours after loading dose Phosphodiesterase Type 4 (PDE-4) Inhibitors Phosphodiesterase Type 4 (PDE-4) Inhibitors Roflumilast Dosing and Uses: 500 mcg PO qd.

12. PHARMACOTHERAPY OF COPD Inhaled Corticosteroids Inhaled Corticosteroids Fluticasone inhaled Dosing and Uses: Initial 88 mcg (2 puffs) inhaled PO BID; max 440 mcg BID. If prior inhaled corticosteroid Tx: initial 88-220 mcg BID; max 440 mcg BID. If prior oral corticosteroid Tx: initial 440 mcg BID, max 880 mcg BID. Budesonide inhaled Dosing and Uses: 360 mcg inhaled PO BID; 720 mcg BID maximum.

13. PHARMACOTHERAPY OF COPD Oral Corticosteroids Oral Corticosteroids Prednisone Dosing and Uses: 40-60 mg PO qDay or divided BID for 3-10 days. Methylprednisolone Dosing and Uses: 2-60 mg/day divided QD/QID PO.

14. PHARMACOTHERAPY OF COPD Beta-Adrenergic Agonist and Anticholinergics Combinations Beta-Adrenergic Agonist and Anticholinergics Combinations Ipratropium and albuterol Dosing and Uses: 2 inhalations QID, additional inhalations PRN; no more than 12 inhalations/day. DuoNeb: 3 mL inhaled via nebulizer q6hr; not to exceed 3 mL q4hr.

15. PHARMACOTHERAPY OF COPD Beta2-Adrenergic Agonist and Corticosteroid Combinations Fluticasone and salmeterol Dosing and Uses Diskus: 1 inhalation PO BID of 50/250. Budesonide and formoterol Dosing and Uses: budesonide 160 mcg/formoterol 4.5 mcg strength: 2 inhalations BID.

16. Smoking Cessation Therapies Nicotine transdermal system Nicotine transdermal system Dosing and Uses: Smoking Cessation >10 Cigarettes/Day Schedule for 21, 14, and 7 mg patches. Step 1 (weeks 1-6): Apply 21 mg patch qDay. Step 2 (weeks 7-8): Apply 14 mg patch qDay. Step 3 (weeks 9-10): Apply 7 mg patch qDay. Smoking Cessation (10 or Less Cigarettes/Day). Omit step 1 patches. Initiate with step 2 patches: Apply step 2 patch qDay (ie, 10 mg/day OR 14 mg/day) for 6 weeks, then Apply step 3 patch qDay (ie, 5 mg/day OR 7 mg/day) for 2 weeks, then discontinue.

17. Smoking Cessation Therapies Nicotine polacrilex Nicotine polacrilex Nicotine-replacement-therapy chewing pieces are marketed in 2 strengths (2 mg, 4 mg). An individual who smokes 1 pack per day should use 4-mg pieces. The 2-mg pieces are to be used by individuals who smoke less than 1 pack per day. Dosing and Uses: weeks 1-6: 1 piece of gum q1-2hr; weeks 7-9: 1 piece of gum q2-4hr; weeks 10-12: 1 piece of gum q4-8hr. <25 cigarettes/day: Initiate with 2 mg. 25 cigarettes/day or more: initiate with 4 mg.

18. Smoking Cessation Therapies Bupropion is an antidepressant Bupropion is an antidepressant Dosing and Uses: 150 mg PO qDay x3 days, then increase to 150 mg BID. Varenicline is a partial agonist selective for alpha4, beta2 nicotinic acetylcholine receptors. Varenicline is a partial agonist selective for alpha4, beta2 nicotinic acetylcholine receptors. Dosing and Uses: 0.5 mg PO qDay x3 days, then 0.5 mg PO BID x4 days, then 1 mg PO BID x11 weeks.