Disease Management of COPD With Pulmonary Rehabilitation: Antibiotics

Antibiotics: Exacerbations may either be caused by a bacterial infection, or alternatively, an infection will develop in the course of exacerbation. The early signs of infectious bronchitis or pneumonia may be a worsening dyspnea and increasing sputum puru-lence. Sputum cultures are typically unhelpful as they may not accurately identify the infecting organism. Chest radiograph changes may not appear soon enough to confirm pneumonia. Fever is often not present as chronic bronchitic patients tend to be colonized by the infecting organisms. The decision to utilize antibiotics is clinical in response to early signs, and the choice of antibiotic is partly based on the patient’s history. COPD patients are generally colonized by H influenzae, S pneumoniae, or M catarrha-lis. Initially, patients may respond to older antibiotics such as amoxicillin, doxycycline, trimethoprim-sulfa, or erythromycin. After several exacerbations, newer agents will be required to achieve the same level of rescue. Because of the involvement of bacterial infection at some stage of exacerbation, antibiotics should generally be included in the exacerbation rescue strategy. canadian neightbor pharmacy

Mucolytic Agents: Mucolytic agents may be adjunctive to facilitate the clearance of thick and tenacious secretions. Whereas coughing is the definitive secretion clearance mechanism, liquefying inspissated mucosal secretions enables movement to the upper airways. Hydration adds moisture at the throat and, for dehydrated patients, increasing fluid intake will probably add local moisture to the airways. Overhydration is of no proven benefit. Mucolytic agents may liquefy secretions by breaking chemical bonds that maintain tenacitv and viscositv.
Hence, these agents are adjunctive to adequate hydration, bronchodilators, steroids, mobilization techniques, and antibiotics; mucolytics are not standalone medicines. Studies on iodinated glycerol have demonstrated improvement in secretion clearance but no significant improvement in lung function. More common drugs such as saturated solution of potassium iodide and guaifenesin have been less impressive. Standard cough syrups have proven disappointing. Acetylcysteine is used in some centers, particularly for cystic fibrosis and bronchiectasis, and is believed to have an antioxidant effect. Patients without significant secretions are not likely to benefit from any of these drugs.
Other Medications: Cor pulmonale is a common complication of COPD. Accordingly, oxygen and diuretics are an integral part of the overall disease management in the advancing stages. As COPD progresses, so do comorbid conditions that may or may not be causally related. Common comorbid conditions include diabetes, atherosclerotic cardiovascular disease, hypertension, arthritis, myopathy, and osteoporosis, the two latter conditions being a consequence of long-term steroid therapy. Thus, the medication list may reflect the addition of diuretics, digoxin, calcium channel blockers, angiotensin-converting enzyme inhibitors, and psychoactive drugs. Additional pharmacologic side effects may include dehydration, electrolyte imbalance, arrhythmia, GI upset, hypotension, and renal failure.

Category: COPD

Tags: COPD, disease management, exercise, psychosocial, pulmonary rehabilitation, self-management