Groups smoking cessation pulmonary rehabilitation may

groups, smoking cessation, pulmonary rehabilitation (may be of benefit to individuals in group B
or 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), and
indacaterol (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 agonists
include 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 (Flovent
HFA, 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