Module 1.0

• Administer vaccinations as appropriate, such as pneumococcal vaccine and annual influenza vaccine.
• Chronic Obstructive Pulmonary Disease (COPD) is a significant public health burden, with asthma and COPD being the most common respiratory diseases.
• Specific methods of detection, intervention, and treatment exist that may reduce the burden of respiratory diseases and promote health.
• Asthma is a chronic inflammatory disorder of the airways characterized by episodes of reversible breathing problems due to airway narrowing and obstruction.
• These episodes can range in severity from mild to life threatening.
• Symptoms of asthma include wheezing, coughing, chest tightness, and shortness of breath.
• Daily preventive treatment can prevent symptoms and attacks and enable individuals who have asthma to lead active lives.
• COPD is a preventable and treatable disease characterized by airflow limitation that is not fully reversible.
• The airflow limitation in COPD is usually progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases, typically from exposure to cigarette smoke.
• Treatment can lessen symptoms and improve quality of life for those with COPD.
• COPD is a general term that covers a variety of other disease labels including chronic obstructive airways disease (COAD), chronic obstructive lung disease (COLD), chronic bronchitis and emphysema.
• Two principal conditions in COPD include Chronic bronchitis, characterized by chronic or recurrent excess mucus secretion with cough that occurs on most days for at least 3 months of the year for at least 2 consecutive years, and Emphysema, characterized by abnormal, permanent enlargement of the airspaces distal to the terminal bronchioles, accompanied by destruction of their walls, without fibrosis.
• Tobacco smoking is the most important and dominant risk factor in the development of COPD but other noxious particles also contribute, such as occupational exposure to chemical fumes, irritants, dust and gases.
• Tobacco exposure is quantified in 'pack-years'.
• The higher the pack-years, the higher the risk for multiple disorders and diseases.
• Physical examination is normal in most patients in milder stages of COPD.
• Other tests can be performed, such as Vital capacity (VC) and Forced vital capacity (FVC).
• A diagnosis of COPD should be considered in any patient who has symptoms of cough, wheeze, regular sputum production or exertional dyspnoea and/or a history of exposure to COPD risk factors.
• If treatment is continued for longer than 2 weeks, employ a tapering oral schedule because of hypothalamic-pituitary-adrenal axis suppression.
• Patients with acute COPD exacerbations may receive a short course of IV or oral corticosteroids.
• The main measurement made is the forced expiratory volume in the first second exhalation (FEV1).
• Residual volume (RV) is the volume of air left in the lungs after a maximal exhalation.
• When airflow limitation becomes severe, patients may have cyanosis of mucosal membranes, development of a “barrel chest” due to hyperinflation of the lungs, increased resting respiratory rate, shallow breathing, pursing of lips during expiration, and use of accessory respiratory muscles.
• A spirometer is used to measure lung volumes and flow rates.
• Other features of exacerbation include chest tightness, increased need for bronchodilators, malaise, fatigue, and decreased exercise tolerance.
• Theophylline and aminophylline produce bronchodilation by inhibiting phosphodiesterase and other mechanisms.
• Theophylline reduces dyspnea, increases exercise tolerance, and improves respiratory drive.
• Chronic theophylline use in COPD improves lung function, including vital capacity and FEV1.
• Spirometry is used to confirm the diagnosis.
• Airflow obstruction is defined as FEV1 less than 80% of that predicted for the patient, and FEV1/FVC less than 0.7.
• Methylxanthines have a very limited role in COPD therapy because of drug interactions and interpatient variability in dosage requirements.
• Patients experiencing COPD exacerbation may have worsening dyspnea, increased sputum volume, or increased sputum purulence.
• Theophylline may also be added to the regimen of patients not achieving optimal response to inhaled bronchodilators.
• Amoxicillin and first-generation cephalosporins are not recommended because of β-lactamase susceptibility.
• Smoking cessation is the only intervention proven to affect long-term decline in FEV1 and slow COPD progression.
• In complicated exacerbations where drug-resistant pneumococci, β-lactamase producing H influenzae and M catarrhalis, and some enteric gram-negative organisms may be present, recommended therapy includes amoxicillin/clavulanate or a fluoroquinolone with enhanced pneumococcal activity (levofloxacin, gemifloxacin, or moxifloxacin).
• Erythromycin is not recommended because of insufficient activity against H influenzae.
• Initiate therapy within 24 hours of symptoms to prevent unnecessary hospitalization and generally continue for at least 7 to 10 days.
• Theophylline may be considered in patients intolerant of or unable to use inhaled bronchodilators.
• If IV therapy is required, a β-lactamase-resistant penicillin with antipseudomonal activity or a third- or fourth-generation cephalosporin with antipseudomonal activity should be used.