Pulmonary
- Critical Care Associates
of East Texas
Jeffrey M.
Shea, M.D., F.C.C.P.
Venkatesh Donty, M.D.
|
Jeffrey M.
Shea, M.D., F.C.C.P. |
|
Introduction Medicine- a substance or preparation used in treating disease, a science and art dealing with the prevention and cure of disease. Patients want to maintain comfortable breathing at rest and in their necessary activities, withstand provoking stimuli, and the ability to withstand acute exacerbation (more severe) with minimum risk and discomfort. Adequate drug therapy of patients with lung disease requires an understanding of the various medications such as bronchodilators, anti-inflammatory, etc. Taking Your Medications Before having any medications prescribed to you, you need to tell your doctor the following:
Medication Guidelines
Questions to ask about your medications:
Classes of Medication There are several classes of medication that may be used alone or used in combination depending on the patient’s lung disease and the severity of the disease. The classes of medication used in lung disease are as follows: Bronchodilators Corticosteroids Nonsteroidal anti-inflammatory Expectorants Antibiotics Oxygen Medications are an important component in the treatment for patients with lung disease. Medications are useful in achieving the short-range goal of relieving symptoms but should be combined with other therapeutic modalities. With the large amounts of medications given to patients with lung disease such as COPD patients, one must be careful to avoid cross-reactions. Patients should also be able to schedule medications and other treatments so that it does not disrupt their life styles. Inhaling bronchodilators a few minutes before activity may improve a patient’s ability to be active by reversing or preventing a bronchospasm. Bronchodilators What are bronchodilators? These medicines help control airway spasms by relaxing the muscles around the bronchial tubes and opening up the airways to allow air to get in and out more easily and mobilize secretions. There are many types of bronchodilators, they work in different ways, but they all help to open up the airways. Bronchodilators come in the form of inhalers, orally, or nebulized. Bronchodilators affect people differently. Some of the side effects are:
Bronchodilators may be referred to as Beta2 Agonist or Anticholinergics. The beta2 agonist are as follows:
These are what are called short-acting and or rescue medicines. They are used for acute attacks, providing quick relief. They start to relax the tightened muscles in the airways within 5 minutes and the effects lasting 4-6 hours. These medications are generally used 2 puffs 4 times a day. The other Beta2 Agonist is:
This medication is the longer-acting bronchodilator. Used regularly, it relaxes the airway muscles within 20-30 minutes and it’s effects last approx. 12 hours. This medication is generally used 2 puffs twice a day. Anticholinergic medication is also used to help dilate the airways and dry secretions. This medication is known as:
It is slow acting, approx. 30-60 minutes before relief is felt, not used for acute attacks. This is also comes combined with albuterol making it Combivent. The use and actions are the same as previously mentioned. It is generally used 2 puffs 4 times a day. Theophylline is a methylxanthine compound, which has bronchodilator activity. It improves mucus clearance, enhances the diaphragm strength and stimulates the respiratory center. It is given as an oral medication. Studies suggest that theophylline may improve lung function and oxygen saturation in sleep. It is used in combination with other bronchodilator therapy and is used as a maintenance therapy for chronic moderate asthma. Patients receiving theophylline will have blood drawn periodically to keep the theophylline level therapeutic. The side effects of theophylline are gastric disturbance, headache, palpitation, dizziness, nausea, hypotension, and chest pain. Representative brands of theophyllin are as follows:
Corticosteroids What are corticosteroids? They are man-made drugs that closely resemble cortisol, a hormone that your adrenal glands produce naturally. Corticosteroids are often referred to by the shortened term "steroids." What are some types of steroids? Some corticosteroid medications include cortisone, prednisone and methylprednisolone. Prednisone is the most commonly used type of oral steroid. Inhaled steroids are Azmacort, Vanceril, Beclovent, AeroBid and Flovent. How are steroids given? These medications are available in several forms that vary in how easily they dissolve or how long they stay in the body. How do steroids work? These medications work by decreasing inflammation and reducing the activity of the immune system. Inflammation is a process in which the body’s white blood cells and chemicals can protect us from infection and foreign substances such as bacteria and viruses. In certain diseases the body’s defense system doesn’t function properly. This may cause inflammation to work against the body’s tissues and cause damage. Inflammation is described as redness, warmth, swelling and pain. Steroids reduce the production of inflammatory chemicals in order to minimize tissue damage. Steroids also reduce the activity of the immune system be affection the function of white blood cells. When are steroids given? These medications are used to treat a variety of conditions in which the body’s defense system malfunctions and causes tissue damage. Steroids are the main therapy for certain diseases. For other conditions, steroids may only be used sparingly, or when other measures have not been successful. Steroids are used as the main treatment for certain inflammatory conditions such as:
For example, steroids can help during a severe flare up of asthma or in severe shortness of breath in COPD. How will the doctor decide of steroids are the right treatment? Decision to prescribe steroids is always made on an individual basis. Your doctor will consider your age, physical activity and other medications you are taking. Your doctor will also make sure you understand the potential benefits and risks of steroids before you start taking them. The potential benefits and risks of steroids vary with:
The side effects depend on the dose, type of steroid and length of treatment. Some side effects are more serious than others are. Common side effects of systemic steroids include:
Not every patient will develop side effects. How often any side effect occurs varies from patient to patient. If steroid use is brief (from a few days to a few weeks); it is possible that none of the listed side effects will occur. If steroid use involves high doses and is prolonged (for a few months to several years), an increase in the number of side effects may occur. Non-steroidal Anti-inflammatory These are known as Cromolyn Sodium (intal) and Nedocromil Sodium (tilade), they are used to help prevent asthma attacks. They come in the form of an inhaler or in a solution for nebulization. It must be used regularly to help prevent attacks and not used during an acute attack. Side effects may include throat irritation, hoarseness and a dry mouth. Expectorants Expectorants and mucolytics are medications that can make breathing easier by helping thin and break up mucus so it is easier to cough up. They are available as liquids and capsules. Your doctor may suggest trying these medications for several weeks or use it as a routine medicine. Some of the expectorants used are as follows:
Avoid expectorants and mucolytics that contain antihistamines or cough suppressants. Patients also need to drink plenty of fluids to thin the mucus and make it easier to bring up. Consult with your doctor on how much fluid to drink. Antibiotics Antibiotics help fight bacterial infections. Having lung disease makes patients more prone to developing such infections. Antibiotics are available as tablets or liquids. They are usually taken for seven to ten days. When taking an antibiotic, it is very important to take the prescribed amount for as long as your doctor tells you to, even if you are feeling better. If you do not take your entire antibiotic as prescribed, you may have trouble getting rid of an infection. When you have signs of running fevers, color changes in mucus, decrease or increase in mucus production, these may be signs of infection and the need for antibiotic therapy. Oxygen Oxygen therapy may not be for everyone with lung disease. Patients with lung disease who complain of shortness of breath may not be due to lack of oxygen. Increased shortness of breath happens when the respiratory muscles work harder to move air in and out of the lungs. The criteria used for patient selection of home oxygen are known as the Nocturnal Oxygen Therapy Trial. These include a PaO2 (oxygen) level in the blood less than or equal to 55 mm Hg or a PaO2 level less than or equal to 59 mm Hg with polycythemia (elevated hemoglobin) or evidence of cor pulmonale (right ventricular dysfunction). Some people may not meet these criteria during the day but may at night during sleep or during exertion. Patients that are placed on oxygen should be re-evaluated monthly. Always follow the doctor’s prescription on the amount to use and the length of time to use it. Never make adjustments without consulting with your doctor first. If you feel anxious about using oxygen, remember oxygen is a medication, and like other medications, following instructions will help make it safe and effective. Using oxygen does not mean that you must be confined to your home. Portable oxygen systems are available which allow you to be as active as you want to be. Guidelines for using oxygen:
There are different delivery types of oxygen that can be used at home. Your doctor, therapist or oxygen supply company will help you choose the system best for you. You are to become familiar with your oxygen system and how it works. With each of the systems oxygen is delivered through a small tube called a nasal cannula. Compressed Oxygen: a compressed oxygen system stores oxygen gas under pressure in a tank. The system has a pressure gauge that tells you how much oxygen is in the tank. It also has a flow meter that regulates the oxygen flow. Oxygen Concentrator: the oxygen concentrator takes nitrogen and other gases from the room air, then removes the other gases leaving only the oxygen. The concentrator runs on electricity and has a flow meter that regulates oxygen flow. Liquid Oxygen: oxygen gas becomes liquid when cooled to a certain temperature. The liquid oxygen system stores oxygen in a special thermal container designed to keep oxygen cooled to a liquid form. When the system is used, oxygen is warmed up until it becomes a gas that can be inhaled. Summary Take medications as your physician prescribes them. Learn and ask question about your medicines, know why you’re taking them. Above all try to learn the names, know how and when to take them or keep a list of your medications handy especially when talking to your doctor.
|
|
