Thank you for your request for information concerning roflumilast (Daliresp®) and COPD. This letter is in response to your inquiry about roflumilast and if it would be a viable option as an additive treatment to help manage severe COPD with acute exacerbations. As you previously mentioned in the clinic, Mr. BB is an elderly male patient who is 66 years old and was diagnosed with hypertension, osteopenia, and tension headaches. He is currently taking two inhalations of Advair® 500/50 twice daily, 2 inhalations of Spiriva Resimat®, and 40 mg of Lipitor every day to manage the symptoms accompanying his chronic disease states. Furthermore, you indicated that Mr. BB has a medication allergy towards simvastatin. In the past, Mr. BB developed muscular …show more content…
As you already know, Chronic Obstructive Pulmonary Disease (COPD), manifests itself when the passageway of air to the lungs is severely obstructed, thus preventing sufficient flow of oxygen into the bloodstream.1 The pathophysiology of COPD is a complex process that is the result of multiple airway diseases that simultaneously contribute to the impairment of airflow in the lungs.1 Specifically, the overlapping outcome of chronic bronchitis and emphysema is the pathogenesis of COPD.1 The risk factor for the COPD is influenced by the individual’s genetics, age, gender, exposure to air pollution, socioeconomic status, and the use of tobacco products.1 The use of tobacco products can increase the development of COPD.1 However, individuals that don’t smoke can also attain COPD.1 Therefore, COPD is not exclusive to individuals that smoke on a daily basis.1 In fact, genetics and the natural aging process plays a part in the development of pulmonary issues.1 For example, it has been proven that a deficiency in the alpha -1 antitrypsin gene is correlated with the development of COPD.1 The natural deterioration of lung tissue, coupled with the long term exposure to environmental elements, explains why the risk of attaining COPD increases as one progresses to the latter stages of their lives.1 In a healthy individual, goblet cells secrete about one liter of mucous that provides a moist surface over the lungs, trachea, and esophagus.1 The cilia on the pseuodocolumnar epithelial cells continuously sweep the mucus in the lungs in an upward motion.1 The cilia sweeps the mucosal trapped debris up, and removes pathogens and other foreign particles out the pulmonary tissue.1 In individuals with COPD, the pathogenesis of the disease creates structural modifications of the lung tissue, which result in deformed and nonfunctioning cilia.2 The lack of functioning cilia leads to the buildup of mucous, pathogens, and subsequent respiratory infections.2 Furthermore, the body tries to combat
I will analyse the prevalence of the condition and what the potential causes may be. My interests have been directed to pre hospital care and community lead treatment packages, which are potentially available to the patient, as this is the acute environment, which I will have contact with in my employment as a paramedic. The initial reading was to understand COPD as a chronic condition, what is COPD? and its prevalence in the population. The (World health organisation, 2000), states that one in four deaths in the world are caused by COPD. In 2010 (Vos T Flaxman etal, 2012), says globally there were approximately 329 million, which is 4.8% of the population who are affected by this chronic condition, In the UK (NICE, 2010), have estimated that 3 million people suffer from COPD, with more yet to be diagnosed. This information about the amount of people living with this condition was surprising, as I little knowledge of its existence. During the early 1960’s (Timothy Q. Howes, 2005), says the term COPD had been designated as a single term unifying all the chronic respiratory diseases. Since then the term COPD, has been sub divided in to three umbrella areas, Bronchitis, Emphysema and Chronic asthma, which are separate conditions, which I have been previously aware of as their individual conditions. The 58 year old patient who we visited,
There are no cure for this disease. However, there are different treatment to prevent further deterioration of the lungs function in order to improve the quality of life of the patient by increasing capacity of their physical activity. One of the main severe complication a patient with COPD can develop is exacerbation. Increased breathlessness, increased sputum volume and purulent sputum are the signs and symptoms of exacerbation. Early detection of the signs of exacerbation can help keep the condition of the patient from worsening. The treatments of COPD mainly aims at controlling the symptoms of exacerbation such as taking inhalers. Patients who are over the age of 35 and ex-smokers with chronic cough and bronchitis are recommended to have spirometer (NICE, 2004). This is because it is possible to delay or prevent patients from developing severe case of COPD is identified before they lose their lungs functions. Oxygen therapy is another treatment for COPD as the patients with this condition has high
R.W. appears with progressive difficulty getting his breath while doing simple tasks, and also having difficulty doing any manual work, complains of a cough, fatigue, and weight loss, and has been treated for three respiratory infections a year for the past 3 years. On physical examination, CNP notice clubbing of his fingers, use accessory muscles for respiration, wheezing in the lungs, and hyperresonance on percussion of the lungs, and also pulmonary function studies show an FEV1 of 58%. These all symptoms and history represented here most strongly indicate the probability of chronic obstructive pulmonary disease (COPD). COPD is a respiratory disease categorized by chronic airway inflammation, a decrease in lung function over time, and gradual damage in quality of life (Booker, 2014).
Emphysema is the most common cause of death from respiratory disease in the United States and is generally caused by several years of heavy cigarette smoking (Olendorf, 2000). When a person smokes, the body’s immune system tries to fight off the invading smoke by using certain substances. These substances can also attack the cells of the lungs, but normally the body is able to release other substances to prevent this. In the case of people who are smokers, this doesn’t happen and the original substances that were released to fight off the smoke also end up injuring the cells of the lungs as well. Eventually, the lungs will not be able to supply enough oxygen to the blood and a host of problems can occur with this. Risk factors that have been identified for emphysema include exposure to tobacco smoke either through active or passive smoking (2nd hand smoke), occupational exposure such as dust or chemicals, ambient air pollution, or genetic abnormalities, including a deficiency of alpha-antitrypsin, an enzyme inhibitor that normally counteracts the destruction of lung tissue by certain other enzymes (Smeltzer, 2010). The symptoms of emphysema develop gradually over many years. It is generally characterized by three primary symptoms: chronic cough, sputum production, and dyspnea on exertion. Other signs and symptoms include weight loss and the development of a
COPD is one of the greatest causes of disability and mortality in the twenty first century with future predictions painting an even graver story. Occupation, genome, and primarily smoking are the main causes of COPD. COPD is the third leading cause of death in America, claiming the lives of 134,676 Americans in 2010. Symptoms are typical of a constant smokers cough which progresses into the debilitating palliative stage of the disease; the development of co-morbidities exacerbates these symptoms. COPD has a complex pathophysiology involving hyperinflation, excessive mucus production and airway remodeling; diagnosis is through lung function tests. COPD is poorly managed with few effective treatments and a poor
Have you ever known a person who smokes and has a hard time doing every day activities, due to difficulty of breath, or constantly coughing. He or she may have Chronic Obstructive Pulmonary Disease, or COPD. COPD is a progressive and treatable lung disease that causes shortness of breath due to obstruction of air way (COPD, 2013). Progressive means that is gradually gets worse over time. It is a combination of chronic bronchitis and emphysema (Causes,2014). Chronic bronchitis is inflammation of the bronchioles, which causes mucus build up (Davis,2016). Emphysema is when the air sacs get enlarged (Smoking, 2016). Since the disease does not have a cure yet it is important to know pathology (path of disease), epidemiology (who is effected in a population), ethology (who is effected genetically), manifestation (symptoms), treatment, and outcome.
Chronic obstructive pulmonary diseases also known as lung cancer is a condition of slow irreversible progressive airway obstruction which gets worse over time. This includes several obstructive diseases of the lungs, including chronic bronchitis, asthma, emphysema, cystic fibrosis and pneumoconiosis. The outcome varies with the consequences with COPD. Approximately 12 million people in the United States have been diagnosed with COPD. According to the Centers for Disease Control and Prevention (CDC), COPD is the fourth leading cause of death in the United States.
History of Present Illness: Mr. Magnuson is a very pleasant 77-year-old gentleman who was previously seen in this office by Elvira Aguila, MD for COPD and hypoxic respiratory failure. He is here today for routine followed up. He was last evaluated in January 2015. Since that time, he states that his dyspnea is worse. He feels that it is related to the weather. He does state that he works around the house, although he does have significant functional limitations because of shortness of breath. His wife also confirms that he is able to do less and less. He has a stable, minimal cough. He is using 4L of oxygen at night as well as, as needed throughout the day. He continues to smoke three to four cigarettes on
When you breath, air travels through tubes in your lungs to millions of tiny air sacs. In a healthy and functioning lung, the airways are open and the air sac fill up with air. Then the air goes back out quickly. COPD makes it hard to get air through the airways and into and out of the air sacs. COPD includes both Chronic Bronchitis and Emphysema. Chronic bronchitis is increased cough and mucus production caused by inflammation of the airways. Emphysema is damage of the air sacs.
A. has a history of smoking for 50 years and being diagnosed with COPD 2 years ago. Development of COPD and its exacerbations may be a leading caused by bacteria, viruses, or environmental pollutants, including cigarette smoke. Coussa, et al, “Expiratory flow limitation (EFL), as a consequence of airway inflammation is the pathophysiological hallmark of COPD.” Exacerbations fundamentally reflect acute worsening of EFL and there is evidence for both increased airway inflammatory activity and worsening airway obstruction as likely explanations.
Chronic obstructive pulmonary disease (COPD) is preventable disease that has a detrimental effects on both the airway and lung parenchyma (Nazir & Erbland, 2009). COPD categorises emphysema and chronic bronchitis, both of which are characterised by a reduced maximum expiratory flow and slow but forced emptying of the lungs (Jeffery 1998). The disease has the one of the highest number of fatalities in the developed world due to the ever increasing amount of tobacco smokers and is associated with significant morbidity and mortality (Marx, Hockberger & Walls, 2014). Signs and symptoms that indicate the presence of the disease include a productive cough, wheezing, dyspnoea and predisposing risk factors (Edelman et al., 1992).
COPD is a multidimensional illness, with a few systemic signs and relationship with various comorbid maladies. The undoubtedly connect amongst COPD and these extrapulmonary conditions is an overflow of provocative arbiters from the lung, as systemic irritation is related with skeletal muscle squandering and cachexia and also with cardiovascular, metabolic, and bone illnesses. More research is expected to comprehend the connections between these illnesses and to scan for regular treatable segments. It appears to be likely that medications, for example, statins, that are as of now used to oversee cardiovascular and metabolic ailments may likewise give an advantage in COPD patients, in spite of the fact that it is critical that randomized fake treatment controlled trials be led to affirm this probability. It is critical to consider how the presence of a comorbid infection may influence the administration of the patient who additionally
All over the world, chronic obstructive pulmonary disease (COPD) is a very significant and prevalent cause of morbidity and mortality, and it is increasing with time (Hurd, 2000; Pauwels, 2000; Petty, 2000). Due to the factor of COPD being an underdiagnosed and undertreated disease, the epidemiology (Pauwels, Rabe, 2004) is about 60 to 85 % with mild or moderate COPD remaining undiagnosed (Miravitlles et al., 2009; Hvidsten et al., 2010).
The World Health Organization (WHO) (2006A) defines COPD as a disease state characterized by airflow limitation that is not wholly reversible. The airflow limitation is usually both progressive and associated with abnormal inflammatory response of the lungs to noxious particles or gases. John's chronic bronchitis is defined, clinically, as the presence of a chronic productive cough for 3 months in each of 2 successive years, provided other causes of chronic cough have been ruled out. (Mannino, 2003). The British lung Foundation (BLF) (2005) announces that chronic bronchitis is the inflammation and eventual scarring of the lining of the bronchial tubes which is the explanation for John's dyspnea. The BLF (2005) believe that when the bronchi become inflamed less air is able to flow to and from the lungs and once the bronchial tubes have been irritated over a long period of time, excessive mucus is produced. This increased sputum results from an increase in the size and number of goblet cells (Jeffery, 2001) resulting in John's excessive mucus production. The lining of the bronchial tubes becomes thickened and an irritating cough develops, (Waugh & Grant 2004) which is an additional symptoms that john is experiencing.
Chronic Obstructive Pulmonary Disease, also known as COPD, is the third leading cause of death in the United States. COPD includes extensive lungs diseases such as emphysema, non-reversible asthma, specific forms of bronchiectasis, and chronic bronchitis. This disease restricts the flow of air in and out of the lungs. Ways in which these limitations may occur include the loss of elasticity in the air sacs and throughout the airways, the destruction of the walls between air sacs, the inflammation or thickening of airway walls, or the overproduction of mucus in airways which can lead to blockage. Throughout this paper I am going to explain the main causes, symptoms, diagnosis, and ways to reduce COPD.