Managing COPD
Nephron Pharmaceuticals Corporation
Sponsored by Masters
14 August 2010
nephron pharmaceuticals corporation
Presenter details
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Michael McGowan
Regional manager and Director of International Sales
and Affairs
mmcgowan@nephronpharm.com
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Marie Moran
Territory Manager, nationwide and International Sales
mmoran@nephronpharm.com
www.nephronpharm.com
Sponsored by Masters
www.masters-uk.com
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nephron pharmaceuticals corporation
Overview
 Understanding
COPD and associated
conditions
 Causes and prevalence of COPD
 Treatment options
 Pharmacist’s role in managing COPD
 Advocacy/patient groups
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What is COPD?
COPD - Chronic Obstructive Pulmonary
Disease is a progressive lung disease.
 Airways become narrower, resulting in
difficulties with breathing.
 Symptoms are treatable but the condition
is irreversible and progressively worsens
over time, unlike asthma where symptoms
come and go.
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Causes of COPD
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Most cases of COPD are caused by long-term exposure to
lung irritants that damage the lungs and airways, i.e. chemical
fumes and organic dust such as grain, cotton, wood, or
mining dust.
However, in the US the most common irritant is cigarette
smoke.
In most patients, symptoms begin to show after the age of 40
years.
On rare occasions, a genetic condition called alpha-1
antitrypsin may play a role in development of COPD. Patients
have low levels of alpha-1 antitrypsin (AAT) — a protein made
in the liver.
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Warning symptoms
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An annual increase/decrease in the amount of sputum
(phlegm)
A change in the color of the sputum to brown, yellow or
green
The presence of blood in the sputum
An unusual increase in the severity of breathlessness
Swelling in the ankles
Unusual increase or decrease in weight
Need to increase the number of pillows to sleep
comfortably
Increasing lack of energy and tiredness
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Umbrella of COPD
■ Chronic Bronchitis
■ Emphysema
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Chronic bronchitis
Chronic bronchitis is an inflammation of
the bronchi.
 Clinically defined as a persistent cough
that produces sputum and mucus for at
least three months in two consecutive
years.
 Tobacco smoke is the main cause.
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Emphysema
Characterized by damage to the alveoli.
 Consequently, the body does not get the
oxygen it needs, making it hard to catch
breath, development of a persistent cough
and trouble breathing during exercise.
 Tobacco smoke is most common cause.
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Prevalence of COPD
The World Health Organization estimates
that 80 million people worldwide have
moderate to chronic COPD.
 In 2005, more than 3 million died of
COPD, equating to 5% of all deaths
globally.
 Almost 90% of COPD deaths occur in low
and middle-income countries.
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COPD rates rising
In the US, COPD is the 4th leading cause
of death. Estimated to become 3rd leading
cause of death worldwide by 2030.
 Affects men and women equally, owing to
increased tobacco use among women in
higher-income countries and greater
exposure to indoor air pollution (biomass
fuel) in low-income countries.
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Economic burden
In 2007, the US spent $42.6 billion on
COPD healthcare costs and loss of
productivity.
 About 24 million Americans have COPD,
according to the American Lung
Association. However, only about half
have been diagnosed with the condition.
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Treatment options
Current pharmacotherapies cannot cure
COPD
 Pharmacotherapies can help control the
condition
- Bronchodilators (β-agonists &
Anticholinergics)
- Inhaled corticosteroids
- Oxygen therapy
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Bronchodilators
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Bronchodilators open the airways and are an
important part of COPD pharmacotherapy.
Bronchodilators relax the smooth muscles
that line the walls of the breathing tubes,
making the airway wider and easier for air to
move through.
Can be administered as tablets, liquids, or
inhalation
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Bronchodilator classes
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Two main classes of Bronchodilators:
Beta- Agonists and Anticholinergics
Beta- Agonists
□ Relax the muscles surrounding the airways
□ Two types: short-acting and long-acting beta
agonists (SABAs and LABAs)
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SABAs
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SABAs – Short-acting β agonist
Example of SABA = Albuterol (a rescue remedy in
breathlessness)
First beta receptor agonist to be marketed
Usually administered through a nebulizer, but can be
given orally as an inhalant or intravenously
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Onset of action within 5 minutes
Provides relief for up to 6 hours
Common side-effects: palpitations, chest pain, rapid
heart rate, tremors or nervousness
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LABAs
LABAs – long Acting β agonist)
 Example of LABAs = Salmeterol and
Formoterol
 Physical effects are similar to SABAs but
effects can last up to 12 hours
 FDA has given LABAs a black box warning
following concerns that they can increase
severity of asthma exacerbations and even
risk of fatal asthma.
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Alpha and beta receptor
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Drug that has a dual affinity for alpha and beta receptors
= Racepinephrine
Racemic mixture of the enantiomorphs of epinephrine
Stimulates alpha properties, acting as a vasoconstrictor
to help reduce mucosal and submucosal oedema
Also stimulates Beta properties that act as
bronchodilators, resulting in the enlargement of airways
and facilitating secretion removal
Administered via inhalation as nebuliser therapy
Onset of pharmacological action is immediate
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Anticholinergics
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Blocks the chemical produced by our bodies that
normally causes the airway to contract
Decreases mucous secretions
Combined with Albuterol or Metaproterenol for
management of COPD. More effective than beta agonist
alone.
Example = Ipratropium Bromide
Usually administered by inhalation
Onset within 15 minutes, therefore not recommended
for emergency use
Half-life of about 6 hours
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Corticosteroids
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For moderate to severe COPD that cannot be controlled
by conventional pharmacotherapy
Do not prevent lung decline over time, but can help
reduce symptoms and reduce frequency of flare-ups
Drug is delivered by inhalation to the lungs, therefore
usually fewer side-effects than oral treatment
However, high doses can affect other parts of the body
and worsen conditions such as osteoporosis
Examples of Inhalation products = Budesonide,
Fluticasone, Triamcinolone, Flunisolide, Beclomethasone
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Oxygen therapy
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For severe COPD and low levels of oxygen in the blood
stream
Supplemental oxygen can:
- improve sleep and mood
- increase mental alertness and stamina
- allow the body to carry out normal functions
- prevent heart failure in people with severe lung disease
However, high doses for prolonged period can be toxic
Surgery may be considered as a last resort
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Pharmacist’s role in managing
COPD
Pharmacists play a crucial role in helping to prevent and
manage COPD:
- diagnosis
- providing accurate and up-to-date information on COPD
- encouraging healthier lifestyle, i.e. smoking cessation
options, diet, exercise
- Helping with compliance of prescribed medication and
help improve the technique when using inhaled medication
- Annual immunization against influenza. Influenza can
lead to exacerbations and respiratory failure.
- Pharmacists can form support teams with other healthcare
professionals
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Useful links
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http://www.aarc.org – American Association of Respiratory Care
http://emphysemafoundation.org – Emphysema Foundation
http://www.nlm.nih.gov – Medline
http://www.nhlbi.nih.gov/health/public/lung/copd/index.htm – National Heart and
Lung Institute of US
http://www.alpha1.org – Alpha1 National Association
http://www.nlhep.org – National Lung Foundation USA
http://www.breathingbetterlivingwell.com – patient support material
http://www.olivija.com/SmokeNoMore
http://www.copdadvocate.com – patient support
http://www.phrma.org - listing of free medication
http://www.thekitchenlink.com – for people with special dietary requirements
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More information
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This is a snapshot of managing COPD, but we
would be delighted to send you more detailed
information
Contact Mike at
mmcgowan@nephronpharm.com or Marie at
mmoran@nephronpharm.com
www.nephronpharm.com
www.masters-uk.com
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Thank you!
Nephron Pharmaceuticals Corporation
Sponsored by Masters
14 August 2010