Drug treatment of bronchitis : a review of medications used in the treatment of chronic obstructive pulmonary disease ( COPD )
Pulmonology / / May 01, 2016
- Anticholinergic agents. Anticholinergics relax bronchial muscles and expand the airways.Bronchodilators do not change the overall course of the disease.However, these drugs help to relieve dyspnea and improve quality of life.
Anticholinergic agents used in COPD include short-acting formulations of ipratropium bromide (Atrovent) and long-acting tiotropium bromide (Spiriva).They are regarded as the standard medications for COPD.One inhalation
combined preparation comprising as ipratropium and beta2-agonist, albuterol (Combivent) may be more effective than either drug alone.
Long-acting anticholinergics, along with inhaled corticosteroids and long-acting beta-2-agonists may reduce the number of exacerbations and improve lung function and quality of life, in order to avoid hospitalization.
For patients who experience frequent symptoms of chronic bronchitis as primary therapy used long-acting beta-agonists, in addition to the regular use of inhaled corticosteroids.
- The beta-2-agonists. All patients with chronic bronchitis II - IV stage it is recommended to take long-acting beta-2-agonists.In patients with non-symptomatic chronic obstructive pulmonary disease, such as during exercise, it is recommended the use of short-acting bronchodilators.
Albuterol (Provento, salamol, Ventolin) is the standard drug short-acting beta-2 agonists.
Other drugs include:
- levalbuterol hydrochloride (Ksopeneks)
- levalbuterol tartrate
- Pirbuterol (Maxair)
There is no evidence that some drugs are beta-2-agonists are better than others.
- Preparations of beta-2-agonists, long-acting. long-acting Bronchodilators are more effective than short-acting for patients with significant long-term symptoms of COPD.
long-acting preparations of beta-2-agonists - salmeterol (Serevent) and formoterol (Foradil) are particularly effective as a long-term maintenance treatment of COPD.They reduce exacerbation by 20 - 25%, and may help prevent bacterial complications in the airways, and actually improve lung function.
Some inhalants combined beta-2-agonists, long-acting corticosteroids (eg, Advair, Seretide and Symbicort).The combination of corticosteroids and long-acting beta2-agonists may reduce exacerbations and improve lung function, but it can also increase the risk of pneumonia.
- Corticosteroids. Corticosteroids are powerful anti-inflammatory drugs:
- Oral corticosteroids are used to treat exacerbations of COPD.Studies show that they are better than inhaled corticosteroids for this purpose.They shorten recovery time and length of stay in the hospital, but they do not reduce mortality and no effect on the long-term development of the disease.Oral corticosteroids should not be routinely used for the stabilization of the disease because of the increased risk of side effects.
Oral corticosteroids are recommended for the initial treatment of patients who are hospitalized with acute exacerbation of COPD.
- Inhaled corticosteroids . Inhaled corticosteroids are the mainstay of therapy of asthma.However, their main use in COPD - treatment of exacerbations, but not for long-term use.
- Theophylline and methylxanthines. These drugs are used in patients with more severe exacerbations, the ineffectiveness of the use of corticosteroids, antibiotics or oxygen.
These drugs do not significantly improve lung function.Some experts believe that the modest benefits of these medicines do not outweigh the risk of toxic side effects.Side effects are generally related to the amount of theophylline in blood.At high doses, they may include nausea, restlessness, headaches, insomnia, vomiting, irregular heartbeat, tremors and convulsions.
- Metered-dose inhalers . This device allows the accurate dose is delivered directly into the lungs.The chamber holding the spacer or enhance delivery, giving the patient more time to inhale the drug.
-P oroshkovye inhalers . dry powder inhalers deliver the drug in powder form directly to the lungs.PI are as effective as MDI, and easier to manage, especially for the elderly.Humidity and high temperatures can affect their performance, so that these devices should not be stored in places with high humidity (eg bathroom) or in areas with high temperature (for example, in the glove compartment of a car in summer months).
- Aerosol inhalers (sprays). They represent a device that sprays a medicine with gas.Metered-dose inhalers are
rapid method of introducing drugs directly into the bronchi, thereby improving respiratory function.
Medicines that improve the expectoration of sputum
Patients with persistent cough accompanied by phlegm drugs should be used, allowing to weaken the production of secretions and facilitate the conclusion of his lungs.
- expectorant. Expectorants, such as guaifenesin, stimulate the excretion of secretory flux secretions from the respiratory tract.Expectorants are not effective in patients with COPD.
- Mucolytics . Mucolytics contain substances that make a thick mucus more watery and allow its easier to cough up.Mucolytics Although usually not recommended for people with COPD have some evidence that they can reduce the number of exacerbations of some patients with moderate to severe COPD.
Anticholinergic drugs appears to help reduce the production of mucus.Preparations of beta-2-agonists, theophylline and improve the quality of the mucus.
- Statins . drugs used to lower cholesterol, may also help protect the lungs of COPD patients, in particular, due to their anti-inflammatory action.However, further studies are required to demonstrate these advantages, as well as to determine the optimum dose of the statin to patients with COPD.
- Alpha-1 antitrypsin. Some patients with deficiency of alpha-1-antitrypsin weekly intravenously administered alpha-1 antitrypsin.Studies have shown that this therapy can not be recommended for patients with COPD deficiency of alpha-1 antitrypsin, because the treatment is costly, and there is sufficient evidence that it reduces the frequency of exacerbations and improve lung function.
Treatment of acute bronchitis or pneumonia in patients with COPD. People with COPD are at increased risk of developing pneumonia, and any infection in the respiratory tract can worsen symptoms and lung function.Patients with acute pneumonia, bronchitis or having symptoms of bacterial infections, such as green or yellow phlegm usually require antibiotics.
Pneumococci, Haemophilus influenzae, moksarella are the most common causes of pneumonia or acute in people with COPD.The choice depends on the antibiotic bacteria and bacterial resistance to common antibiotics.Prophylactic antibiotics in patients with frequent exacerbations is not recommended, as this practice contributes to the development of bacterial resistance.
- Beta-lactam antibiotics - new drugs.They break the cell walls of bacteria and are less toxic.
- penicillin. Penicillin was the first antibiotic.Many forms of this drug is still widely used today:
- derivatives of penicillin - aminopenicillin, in particular, amoxicillin (Amoxil, flemoksin, Trimox, Wymox), are currently the most common in use.
- Amoxicillin is inexpensive, and at one time he was very effective against S. pneumoniae.Unfortunately, the resistance of bacteria to amoxicillin has increased significantly.Ampicillin has a similar effect, but it requires higher doses and has a more severe gastrointestinal side effects than amoxicillin.
- amoxicillin-clavulanate (Augmentin, amoxiclav), supplemented with antibiotic clavulanic acid, which increases its efficiency.It is effective against a broad spectrum of bacteria and is used for more severe exacerbations.
- Cephalosporins.Most of these antibiotics are not very effective against bacteria that have developed resistance to penicillin, and they are used for more severe exacerbations.They are classified according to their generations:
- Second generation: cefaclor (tseklor), cefuroxime (tseftin), cefprozil (tsefzil) and loracarbef (lorabid).
- third generation: cefpodoxime (Wanting), cefdinir (Omnisef) tsefditoren (Spectracef), cefixime (Supraks) and ceftibuten (Tsedeks), ceftriaxone (Rocephin).
These antibiotics are effective against a broad spectrum of gram-negative bacteria, and also some of them are able to treat infections of penicillin for pneumonia.
- fluoroquinolones (quinolones).Fluoroquinolones ( "quinolones") result in permanent impairment of DNA and RNA biosynthesis in the microbial cell.These antibiotics are used for more severe exacerbations.
- "respiratory quinolones" are currently the most effective drugs against a wide spectrum of bacteria.These include levofloxacin (Levaquin), and gemifloxacin (Factive).Levofloxacin was the first drug approved specifically for penicillin-resistant bacteria pneumonia.Some of the newer quinolones be taken only once a day.
- fourth generation fluoroquinolones - moxifloxacin (Avelox) and klinafloksatsin (is still in development) are proving effective against anaerobic bacteria.
When it comes to the treatment of exacerbations of chronic bronchitis, the so-called second line antibiotics (amoxicillin clavulanate, macrolides, second- or third-generation cephalosporins and fluoroquinolones) is more effective and safe when compared with the first generation of antibiotics (ampicillin, doxycyclineand trimethoprim / sulfamethoxazole).
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- Macrolides and azalides. Macrolides and azalides also affect the genetics of bacteria.These drugs include:
- Azithromycin (Zetamaks, Z-factor)
- Clarithromycin (Biaxin)
- Roxithromycin (Rulid)
These antibiotics active against atypical bacteria such as Mycoplasma and Chlamydia.Macrolides and azalides are also effective against S. pneumoniae and M.satarrhalis but growing bacterial resistance to these drugs.Studies have shown that the use of azithromycin in addition to conventional treatment reduces COPD exacerbations and improve quality of life.However, long-term use of azithromycin in some patients, there was a slight decrease in hearing, and heart rhythm disturbances.
- Tetracyclines . Tetracyclines inhibit bacterial growth.They include doxycycline, tetracycline and minocycline.These antibiotics may be effective against S. pneumoniae and M.satarrhalis but bacteria resistant to penicillin, frequently also resistant to doxycycline.Side effects of tetracycline include skin reaction to sunlight, a burning sensation in the throat and discoloration of the teeth.
- Trimethoprim-sulfamethoxazole . Trimethoprim-sulfamethoxazole (Bactrim, Septra and Cotrimoxazole) cheaper than amoxicillin, and is particularly effective for adults with mild bacterial infections of the upper respiratory tract, allergic to penicillin.The drug is no longer effective against certain strains of streptococci.It should not be used in patients whose infection occur after dental work, or in people who are allergic to sulfa drugs.Allergic reactions can be very serious.