Q. I have patients previously diagnosed as Asthma who are now classified as COPD. Should I keep them on inhaled steroids?
A. If you have a strong suspicion that your patient has COPD rather than asthma (smoking history, progressive shortness of breath), then you should slowly reduce the dose of inhaled steroids (over several months - e.g. 25% reduction every 2-3 months). In most patients with COPD you will be able to withdraw the inhaled steroid completely, without any increase in symptoms or change in lung function.
Q. What is a recommended 'steroid trial' for COPD?
A. The most frequently used regime for a steroid trial is to give oral prednisolone (40mg daily in a single morning dose) for 2 weeks. It is best to make measurements of peak expiratory flow (PEF) twice a day for 2 weeks before starting oral steroids in order to get a baseline value and then during the treatment period. FEV, should be measured at the beginning and end of the baseline period and after the inhaled steroids. A steroid trial is considered positive if FEV, or mean PEF increase by more than15%, when a diagnosis of asthma is made. It is important to remember that some patients will have asthma and COPD at the same time.
Q. What is the role, if any, for oral steroids in COPD?
A. Oral steroids are used in a formal trial of steroids and may be useful in acute exacerbations of COPD. They should not be used as a maintenance treatment because of the side effects of long-term steroid therapy.
Q. With a newly diagnosed COPD patient should I initiate steroid therapy, if so how?
A. If a patient has COPD with no evidence of response to oral steroids (negative steroid trial) then inhaled steroids should not be used. It is possible that inhaled steroids may alter the accelerated annual rate of decline in lung function with age.
Q. How will I know if a COPD patient is benefiting from steroid therapy?
A. The best way to determine whether inhaled steroids are beneficial is to slowly reduce the dose. If FEV, or mean PEF show no deterioration, the inhaled steroid can be completely withdrawn.
Q. Will COPD patients need to be on long-term steroid therapy? If so, what about side effects?
A. Only patients who have shown a positive response to oral steroids (steroid trial) should be on inhaled steroids.
What risk factors and symptoms did Jessica present with prior to the physical examination that suggested a pulmonary disorder?
R.S.’s clinical findings as a consequence of his chronic bronchitis are likely to include: being overweight, experiencing shortness of breath on exertion, producing excessive amount of sputum, having a chronic productive cough, as well as edema and hypervolemia just to name a few. (Copstead & Banasik, 548) Some of these signs and symptoms would be different if R.S. had emphysematous COPD. In emphysema (or “pink puffers”), there is weight loss, the cough is absent or negligible, and edema is not present. While central cyanosis and jugular vein distention are present in late chronic bronchitis, these pathologic manifestations are absent in emphysema. . (Copstead & Banasik, 549)
Truitt, T. W. (2003). Levalbuterol compared to racemic albuterol: Efficacy and outcomes in patients hospitalized with COPD or asthma. Chest , 128-135.
There are two forms of bronchodilators, a short acting and a long acting form. Short acting relieves or stops asthma symptoms and is very helpful during an attack. They are also called ‘rescue’ medications because they are best for treating sudden or severe asthma symptoms. Long acting bronchodilators are used to control asthma, they take longer to work but they also last longer, up to 12 hours, whereas a short acting would only last for about 4-5 hours. Ventolin is a short acting form, it is the recommended medication to use 15-20 mins before exercising.
Mrs. Jones has a history of COPD. She was already taking albuterol for her illness and it was ineffective when she took it that day. Mrs. Jones had been a smoker but had quit several years ago. According to Chojnowski (2003), smoking is a major causative factor in the development of COPD. Mrs. Jones's primary provider stated that she had a mixed type of COPD. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) was established to address the growing problem of COPD. The GOLD standards identify three conditions that contribute to the structural changes found in COPD: Chronic bronchiolitis, emphysema, and chronic bronchitis. A mixed diagnosis means that the patient has a combination of these conditions (D., Chojnowski, 2003). Mrs. Jones chronically displayed the characteristic symptoms of COPD. "The characteristic symptoms are cough, sputum production, dyspnea on exertion, and decreased exercise tolerance." (D., Chojnowski, 2003, p. 27).
contain the effects that you want to see. You also want to take different steroids that
Oxygen, inhaled bronchodilators, inhaled steroids, combination inhalers, oral steroids, phosphodiesterase-4 inhibitors and theophylline are effective medications for COPD (Mayo Clinic, 2016). “Patients with COPD have persistent high levels of CO2, their respiratory centers no longer respond to increased levels of CO2 by stimulating breathing. Therefore, COPD patients with more severe hypoxemia are at higher risk of CO2 retention from uncontrolled CO2 administration” (Van Houten, p. 13). For nurses, “It is important to administer the lowest amount of O2 necessary to patients” (Van Houten, p. 13). Some COPD medicines are used with inhaler and nebulizer devices. It is important to teach patients how to use these devices correctly. (Potter & Perry,
Carone M, D. C. ( 2007). Clinical Challenges In COPD[e-book]. (Oxford: Clinical Pub) Retrieved March 24, 2014, from (EBSCOhost).
The problems with performance enhancing drugs are that they give the user unfair advantages over other athletes and come with many health risks such as baldness. Steroid use can result in very substantial legal consequences and can ruin the user’s reputation. There are many alternatives to steroids but not all of them are safe. Different organizations have different rules on steroids, but in most cases, the user can get suspended, fined, or even both. Various types of steroids can have various short-term or long-term side effects. There are several types of steroids, the most popular ones being anabolic steroids. Historically, steroids have been around for many years, but the debate surrounding them started recently, more specifically a few decades ago. An important term to know is anabolic steroids which are made to work with the user’s muscle mass. Another term to know is clarified by Ida Walker, author of the book, Steroids: Pumped Up and Dangerous, published by Mason Crest Publishers in 2008, defines, peliosis hepatis is a rare condition in which cysts filled with blood form in the liver, if the cysts were to pop then internal bleeding would occur. A positive argument about steroids is stated by Adrianne Blue, author of the essay, “Performance Enhancing Drugs Should Be Legal,” published in the book Athletes and Drug Use, published in 2009, disputes, “Blue concludes that legalizing performance- enhancing drugs can protect athletes from dangerously abusing them.” The utilization of performance enhancing drugs has left a giant scar on sports and has compromised the achievements of many athletes; therefore, they are transforming the sports world into a drug filled world.
Anabolic steroids are drugs containing, or hormone-like substances, that are used to increase strength and promote muscle growth. They were first developed in the 1930s in Europe to treat undernourished patients and to promote healing after surgery. Competitive weightlifters began using steroids in the 1950s as a way to increase their athletic performance. Use gradually spread throughout the world among athletes in other has been estimated that at least one in 15 male high school seniors in the United States--more than a half-million boys--has used steroids. Some are athletes attempting to increase their strength and size; others are simply youths attempting to speed up their growth to keep pace with their peers. In some countries, anabolic steroids are available over the counter. In the United States, a doctor's prescription is necessary.
Although steroids have many negative effects, they have many needed medical purposes. Androgens have many legitimate medical uses, such as the use for treatment of hypogonadal men to compensate for the lack of endogenous production. Anabolic steroids are also helpful for the treatment of certain adolescent diseases, some types of anemias, and for a relatively rare form of edema. Other clinical uses focus on the tissue building and anti-catabolic effects, such as in the treatment of burn victims, AIDS, or HIV positive patients, or patients malnourished from disease or old age (Bellino 1).
Someone diagnosed with COPD must understand that the damage done to the lungs by this disease is not reversible. The prognosis is one of stopping further damage to the lungs. To minimize this damage the person is treated for symptoms of the disease and not healing of it. The symptoms of COPD usually show up after the lungs have been significantly damaged and due to this late formation of symptoms and their inability to ...
Chronic obstructive pulmonary disease (COPD) is preventable disease that has a detrimental effects on both the airway and lung parenchyma (Nazir & Erbland, 2009). COPD categorises emphysema and chronic bronchitis, both of which are characterised by a reduced maximum expiratory flow and slow but forced emptying of the lungs (Jeffery 1998). The disease has the one of the highest number of fatalities in the developed world due to the ever increasing amount of tobacco smokers and is associated with significant morbidity and mortality (Marx, Hockberger & Walls, 2014). Signs and symptoms that indicate the presence of the disease include a productive cough, wheezing, dyspnoea and predisposing risk factors (Edelman et al., 1992). The diagnosis of COPD is predominantly based on the results of a lung function assessment (Larsson, 2007). Chronic bronchitis is differentiated from emphysema by it's presentation of a productive cough present for a minimum of three months in two consecutive years that cannot be attributed to other pulmonary or cardiac causes (Marx, Hockberger & Walls, 2014) (Viegi et al., 2007). Whereas emphysema is defined pathologically as as the irreversible destruction without obvious fibrosis of the lung alveoli (Marx, Hockberger & Walls, 2014) (Veigi et al., 2007).It is common for emphysema and chronic bronchitis to be diagnosed concurrently owing to the similarities between the diseases (Marx, Hockberger & Walls, 2014).
Steroids can have many health effects on your body. Many doctors say not to use steroids because of the possible long term effects. A source from a reputable website says, “It is speculated that possible long-term effects may include adverse cardiovascular ef...
The clinical manifestation one may see in patients with chronic bronchitis are chronic cough, weight loss, excessive sputum, and dyspnea. Chronic cough is from the body trying to expel the excessive mucus build up to return breathing back to normal. Dyspnea is from the thickening of the bronchial walls causing constriction, thereby altering the breathing pattern. This causes the body to use other surrounding muscles to help with breathing which can be exhausting. These patients ca...