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groups, smoking cessation, pulmonary rehabilitation (may be of benefit to individuals in group Bor D), oxygen therapy, avoidance of occupational and environmental irritants, maintaining physical activity, or surgery (American Lung Association, n.d.; Arcangelo, Peterson, Wilbur, & Reinhold, 2017; GOLD, 2018; Mayo Clinic, 2017).Pharmacotherapy for COPD
Pharmacotherapy is recommended as part of the GOLD guidelines for 2018, and the goals of therapy are to decrease risks and symptoms. Medications used to treat COPD include bronchodilators, inhaled steroids, combination inhalers, oral steroids, antibiotics, methyl-xanthines (theophylline, aminophylline) and phosphodiesterase-4 inhibitors. Bronchodilators make it easier to breathe by relaxing muscles around the airways. Long-acting and short acting bronchodilators can be delivered through nebulizers or inhalers and exist as Anticholinergics and Beta2-Agonists. Long-acting bronchodilators are generally used for maintenance and start to work in minutes and can last as long as 24 hours. They include tiotropium (Spiriva), salmeterol (Serevent), arformoterol (Brovana), formoterol (Perforomist, Foradil), aclidinium (Tudorza), andindacaterol (Arcapta). Short-acting bronchodilators are generally used in emergency situations, and have a quick onset, but short duration and include albuterol (ProAir HFA, Ventolin HFA, etc.), ipratropium (Atrovent), and levalbuterol (Xopenex HFA). Side effects of bronchodilators may include nervousness, sleeping problems, increase in heart rate, palpitations, fatigue, headaches, restlessness, and nausea (Arcangelo, Peterson, Wilbur, & Reinhold, 2017; Lung Institute, 2017; Mayo Clinic, 2017). Adverse reactions that occur with beta2-adrenergic agonistsinclude central nervous system (CNS) stimulation, increased skeletal muscle activity, hypokalemia, and hyperglycemia. They are contraindicated in people with known sensitivity to beta2-adrenergic agonists or their components, and should be used cautiously in patients with hyperthyroidism, diabetes mellitus, CV disease, or seizure disorders. Adverse reactions that occur with inhaled anticholinergics are cough, dry mouth, and eye issues should the product get into the eyes. They are contraindicated in patients with known sensitivity to themselves or any of their components and are to be used cautiously in patients with prostatic hyperplasia, myasthenia gravis, bladder neck obstruction, and narrow-angle glaucoma (Arcangelo, Peterson, Wilbur, & Reinhold, 2017).Inhaled steroids help prevent exacerbations of the disease and reduce inflammation of the airways. They are helpful for managing people with frequent episodes of COPD exacerbation. Examples of inhaled steroids are budesonide (Pulmicort Flexhaler, etc.), and fluticasone (FloventHFA, Flonase, etc.). Side effects may present as oral infections, bruising, and hoarseness (Mayo Clinic, 2017). Combination inhalers are an inhaled steroid combined with a bronchodilator. Examples are budesonide combined with formoterol (Symbicort) and fluticasone combined with salmeterol (Advair). Oral steroids are used to treat individuals who have either moderate or severe acute