Pharmacotherapy
There is currently no pharmacologic treatment that mitigates the rate of decline of lung function or reduces or abolishes symptoms, but pharmacotherapy can improve exercise tolerance, reduce the number and severity of exacerbations, and improve lung function ( Table 106-1 ). Pharmacotherapy should be based on the severity of disease and the patient's tolerance for certain drugs. In addition, a stepwise approach may be helpful.
TABLE 106-1
Pharmacologic Agents for COPD Therapy
Agent Recommended Dose Range Notes
ANTICHOLINERGICS
Short Acting
Ipratropium bromide
MDI, 20, 40 µg/inhalation 2-4 puffs 4-6 times per day Poorly absorbed systemically; few side effects; should be used regularly (not prn)
Solution for nebulization, 500 µg/2.5 mL 3-4 times per day, separate doses by 6-8 hr Precautions with narrow-angle glaucoma
Long Acting
PharmacotherapyThere is currently no pharmacologic treatment that mitigates the rate of decline of lung function or reduces or abolishes symptoms, but pharmacotherapy can improve exercise tolerance, reduce the number and severity of exacerbations, and improve lung function ( Table 106-1 ). Pharmacotherapy should be based on the severity of disease and the patient's tolerance for certain drugs. In addition, a stepwise approach may be helpful.TABLE 106-1Pharmacologic Agents for COPD TherapyAgent Recommended Dose Range NotesANTICHOLINERGICSShort ActingIpratropium bromideMDI, 20, 40 µg/inhalation 2-4 puffs 4-6 times per day Poorly absorbed systemically; few side effects; should be used regularly (not prn)Solution for nebulization, 500 µg/2.5 mL 3-4 times per day, separate doses by 6-8 hr Precautions with narrow-angle glaucomaLong Acting
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