Chronic obstructive pulmonary disease (COPD) Part 3
Antibiotics and corticosteroids
Patients with COPD often suffer from chest infections so are frequently prescribed a short course of broad-spectrum antibiotics such as amoxicillin, tetracycline, or erythromycin. Oral corticosteroids may be needed in short courses of one or two weeks for acute flare ups. They should be commenced as the flare-up starts for best effect. Long term use of corticosteroids cause side effects including weight gain, osteoporosis, stomach ulcers and fluid retention. Side effects are minimal for short term courses. They should be taken as a single dose in the morning and after food. Enteric coated versions such as Deltacortil® reduce stomach irritation.
Longer term maintenance antibiotic
The use of long-term maintenance (prophylactic) antibiotic is sometimes considered for patients at increased risk of acute exacerbations of COPD. They are shown to have anti-inflammatory effects which has much benefit as their anti-bacterial effect. Macrolides like azithromycin and erythromycin are most frequently prescribed. Antibiotic maintenance therapy is azithromycin 250 mg once daily (or 250mg 3 days per week), for 1 year reduce frequency of acute exacerbations.
Used to administer bronchodilators and corticosteroids in severe COPD as they allow administration of large doses of the drug. If relief from nebulised bronchodilators is not sufficient, intravenous aminophylline may be needed.
Other types of treatment
Long-term oxygen therapy
In severe or end stage COPD, when the oxygen in the blood gets very low (hypoxia), the patient may need oxygen therapy. Hypoxic patients (PaO2 < 7.8 kPa) with evidence of cor pulmonale (enlargement of right ventricle in heart) have a 5-year survival of less than 50%. Long term oxygen therapy has been shown to increase survival in persistent daytime hypoxaemia (PaO2 < 7.3 kPa). There is no survival benefit of oxygen in patients with lesser degrees of hypoxaemia. However oxygen does increase survival for patients with severe chronic COPD with hypoxaemia. Oxygen must be used for at least 15 hours a day. The tubes from the machine are long enough to enable a patient to move around their home while connected. Patients must not smoke when using an oxygen concentrator due to fire risk.
In rare cases, hospitalisation may be required for exacerbations of COPD. In hospital, patients usually receive oxygen, antibiotics (if necessary) and a nebuliser to help ease symptoms. Hospitalisations give better outcomes in acute exacerbations.
Lung transplantation is rare in cases of COPD and it is usually only suggested if life expectancy is less than two years. Although lung transplantations are usually very successful, the patient will need to take immunosuppressants medication for the rest of their life to prevent organ rejection.
Lung volume reduction surgery (LVRS)
Lung volume reduction surgery (LVRS) is when the damaged parts of the lung are removed during surgery. It improves symptoms but increases pneumonia risk and risk of developing an air leak where the lung has been re-sealed.
Covid Booster Vaccine
If you have COPD, you may be at more risk from COVID-19. Ask your doctor if you are eligible for the next Covid 19 booster. Whelehans Pharmacy Pearse St have a weekly walk-in clinic for Covid-19 boosters. Call 0449334591 for more.
Convenient Flu Vaccination Service at Whelehans
Whelehans offer flu vaccine at our Pearse St and Clonmore store most days for adults and children. You can book online on the Whelehans Pharmacy website or ring either pharmacy. Flu vaccine is €25 (€20 if you book online) or free with medical or doctor visit card. It is free for older people and those with long term conditions (including COPD) and healthcare workers.
For comprehensive and free health advice and information call in to Whelehans, log on to www.whelehans.ie or dial 04493 34591 (Pearse St) or 04493 10266 (Clonmore). Email queries to firstname.lastname@example.org. Find us on Facebook.