Focus

Management of COPD exacerbations: pharmacotherapeutics of medications

Respiratory Nurse Specialist and Independent Nurse Prescriber, Mater Hospital, Belfast

Published Online:10 Jul 2020https://doi.org/10.12968/bjon.2020.29.13.738

Abstract

Chronic obstructive pulmonary disease (COPD) is widely established as a health challenge, with predictions that it will be the third leading cause of global mortality and reduced health status within the next 10 years. Exacerbations of COPD are now the second largest cause of emergency hospitalisation in the UK. The respiratory clinical nurse specialist has an active role in the acute management of COPD exacerbations in the hospital setting, and it is essential that prescribing decisions are made based on the best available evidence. This article critically evaluates the pharmacotherapeutics and evidence base for the use of two medications, salbutamol and amoxicillin, in treating unstable COPD, and discusses implications for clinical practice.

References

Amin A, Elansary A, Issa Y. Colorimetric determination of amoxycillin in pure form and in pharmaceutical preparations. Talanta. 1994;41(5):691–694. https://doi.org/10.1016/0039-9140(94)80050-2 Crossref, Medline, Google Scholar
Ashley C, Dunleavy A. The renal drug handbook. 4th edn. London: Radcliffe Publishing; 2014 Google Scholar
Barnes PJ, Drazen J, Rennard SI, Thomson NC. Asthma and COPD: basic mechanisms and clinical management. London: Academic Press; 2009 Google Scholar
Bazargani YT, de Boer A, Leufkens HGM, Mantel-Teeuwisse AK. Essential medicines for COPD and asthma in low and middle-income countries. Thorax. 2014 Dec;69(12):1149–1151. https://doi.org/10.1136/thoraxjnl-2014-205249 Crossref, Medline, Google Scholar
Bearsley MB, Travis WD, Rubin E. The respiratory system. In: Rubin RStrayer DS (eds). Rubin's pathology: clinicopathologic foundations of medicine. 6th edn. Philadelphia (PA): Wolters Kluwer Health; 2012:537–604 Google Scholar
Billington CK, Hall IP. Real time analysis of β2-adrenoceptor-mediated signalling kinetics in human primary airway smooth muscle cells reveals both ligand and dose dependent differences. Respir Res. 2011;12(1):89. https://doi.org/10.1186/1465-9921-12-89 Crossref, Medline, Google Scholar
Boarder M, Newby D, Navti P. Pharmacology for pharmacy and the health sciences: a patient-centred approach. Oxford: Oxford University Press; 2010 Google Scholar
Boe J, Dennis JH, O'Driscoll BR, et al.. European Respiratory Society Guidelines on the use of nebulizers. Eur Respir J. 2001;18(1):228-242. https://doi.org/10.1183/09031936.01.00220001 Medline, Google Scholar
Boushey HA. Drugs used in asthma. In: Katzung BGMasters SBTrevor AJ (eds). Basic and clinical pharmacology. 12th edn. London: McGraw-Hill; 2012:339–357 Google Scholar
British Lung Foundation. The battle for breath—the impact of lung disease in the UK. 2016. https://tinyurl.com/yarq86a9 (accessed 24 June 2020) Google Scholar
Burt L, Corbridge S. COPD exacerbations. Am J Nurs. 2013;113(2):34-44. https://doi.org/10.1097/01.NAJ.0000426688.96330.60 Crossref, Medline, Google Scholar
Bush K. β-lactam antibiotics. In: Finch RGGreenwood DWhitley RJNorrby SR (eds). Antibiotic and chemotherapy. 9th edn. London: Elsevier; 2010:200–226 Crossref, Google Scholar
Cates CJ, Welsh EJ, Rowe BH. Holding chambers (spacers) versus nebulisers for beta-agonist treatment of acute asthma. Cochrane Database Syst Rev. 2013;2013(9):CD000052. https://doi.org/10.1002/14651858.CD000052.pub3 Google Scholar
Cazzola M, Rogliani P, Ruggeri P et al.. Chronic treatment with indacaterol and airway response to salbutamol in stable COPD. Respir Med. 2013;107(6):848–853. https://doi.org/10.1016/j.rmed.2013.02.008 Crossref, Medline, Google Scholar
Crompton GK. Problems patients have using pressurized aerosol inhalers. Eur J Respir Dis Suppl. 1982;119:101–104 Medline, Google Scholar
De Alwis W, Weiner Y. Emergency medicine MCQs. Sydney, Australia: Churchill Livingstone; 2012 Google Scholar
Decramer M, Janssens W, Miravitlles M. Chronic obstructive pulmonary disease. Lancet. 2012;379(9823):1341–1351. https://doi.org/10.1016/S0140-6736(11)60968-9 Crossref, Medline, Google Scholar
Department of Health, Social Services and Public Safety. Service framework for respiratory health and wellbeing 2015-18. 2015. https://tinyurl.com/y7qrd8a5 (accessed 24 June 2020) Google Scholar
Dong YH, Hsu CL, Li YY, Chang CH, Lai MS. Bronchodilators use in patients with COPD. Int J Chron Obstruct Pulmon Dis. 2015;10:1769-1779. https://doi.org/10.2147/COPD.S86198 Medline, Google Scholar
Drawz SM, Bonomo RA. Three decades of beta-lactamase inhibitors. Clin Microbiol Rev. 2010;23(1):160–201. https://doi.org/10.1128/CMR.00037-09 Crossref, Medline, Google Scholar
Ebadi M. Desk reference of clinical pharmacology. 2nd edn. London: CRC Press; 2008 Google Scholar
Electronic Medicines Compendium. Ventolin Evohaler 100 micrograms. https://www.medicines.org.uk/emc/product/850/smpc (accessed 24 June 2020) Google Scholar
Ehrhardt C, Kneuer C, Bies C, Lehr CM, Kim KJ, Bakowsky U. Salbutamol is actively absorbed across human bronchial epithelial cell layers. Pulm Pharmacol Ther. 2005;18(3):165–170. https://doi.org/10.1016/j.pupt.2004.11.007 Crossref, Medline, Google Scholar
Gardenhire DS. Rau's respiratory care pharmacology. 9th edn. St. Louis (MO): Mosby/Elsevier; 2016 Google Scholar
Geddes AM, Gould IM. Ampicillin, amoxicillin and other ampicillin-like penicillin. In: Grayson MLCrowe SMMcCarthy JSet al., (eds.) Kucers' the use of antibiotics: a clinical review of antibacterial, antifungal and antiviral drug. 6th edn. London: CRC Press; 2010:65–93 Crossref, Google Scholar
Gladson B. Pharmacology for rehabilitation professionals. 2nd edn. St. Louis (Mo): Elsevier; 2011 Google Scholar
Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease. 2019 Report. 2019. https://tinyurl.com/y3blokvj (accessed 24 2020) Google Scholar
Goossens H, Ferech M, Vanderstichele R, Elseviers M; ESAC Project Group. Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Lancet. 2005;365(9459):579–587. https://doi.org/10.1016/S0140-6736(05)70799-6 Crossref, Medline, Google Scholar
Hinkle JL, Cheever KH. Brunner and Suddarth's textbook of medical-surgical nursing. 13th edn. London: Lippincott Williams and Wilkins; 2014 Google Scholar
Hodgson BB, Kizior RJ. Saunders nursing drug handbook. St Louis (MO): Elsevier; 2014 Google Scholar
Hurst JR, Perera WR, Wilkinson TMA, Donaldson GC, Wedzicha JA. Systemic and upper and lower airway inflammation at exacerbation of chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2006;173(1):71–78. https://doi.org/10.1164/rccm.200505-704OC Crossref, Medline, Google Scholar
Jeske AH. Mosby's dental drug reference. 11th edn. St. Louis (MO): Elsevier; 2014 Google Scholar
Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. https://bnf.nice.org.uk/drug/salbutamol.html (accessed 24 June 2020) Google Scholar
Jones PW, Chen WH, Wilcox TK, Sethi S, Leidy NK; EXACT-PRO study group. Characterizing and quantifying the symptomatic features of COPD exacerbations. Chest. 2011;139(6):1388–1394. https://doi.org/10.1378/chest.10-1240 Crossref, Medline, Google Scholar
Karner C, Chong J, Poole P. Tiotropium versus placebo for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2014;7(7):CD009285. https://doi.org/10.1002/14651858.CD009285.pub3 Google Scholar
Kaur SP, Rao R, Nanda S. Amoxicillin: a broad spectrum antibiotic. International Journal of Pharmacy and Pharmaceutical Sciences. 2011;3(3):30–37 Google Scholar
Kee JL, Hayes ER, McCuiston LE. Pharmacology: a patient-centred nursing process approach, 8th edn. St Louis (MO): Elsevier; 2015 Google Scholar
Koch A, Pizzichini E, Hamilton A et al.. Lung function efficacy and symptomatic benefit of olodaterol once daily delivered via Respimat® versus placebo and formoterol twice daily in patients with GOLD 2–4 COPD: results from two replicate 48-week studies. Int J Chron Obstruct Pulmon Dis. 2014;9(1):697–714. https://doi.org/10.2147/COPD.S62502 Crossref, Medline, Google Scholar
Laube BL, Janssens HM, de Jongh FHC et al.; European Respiratory Society International Society for Aerosols in Medicine. What the pulmonary specialist should know about the new inhalation therapies. Eur Respir J. 2011;37(6):1308–1417. https://doi.org/10.1183/09031936.00166410 Crossref, Medline, Google Scholar
Lavorini F, Fontana GA. Targeting drugs to the airways: the role of spacer devices. Expert Opin Drug Deliv. 2009;6(1):91–102. https://doi.org/10.1517/17425240802637862 Crossref, Medline, Google Scholar
Lilley LL, Rainforth Collins SR, Snyder JS. Pharmacology and the nursing process. 8th edn. St Louis: Elsevier; 2017 Google Scholar
Llor C, Moragas A, Hernández S, Bayona C, Miravitlles M. Efficacy of antibiotic therapy for acute exacerbations of mild to moderate chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2012;186(8):716–723. https://doi.org/10.1164/rccm.201206-0996OC Crossref, Medline, Google Scholar
Lynes D. Pathological processes aetiology and natural history. In: Lynes D (ed). The management of COPD in primary and secondary care. Keswick: M&K Publishingl 2007:5–14 Google Scholar
MacNee W. Pathology, pathogenesis, and pathophysiology. BMJ. 2006;332(7551):1202–1204. https://doi.org/10.1136/bmj.332.7551.1202 Crossref, Google Scholar
MacNee W. Pathology and pathogenesis. In: Currie GP (ed). ABC of COPD. Chichester: Wiley and Sons; 2011: 6–11 Google Scholar
Mahler DA, Kerwin E, Ayers T et al.. FLIGHT1 and FLIGHT2: efficacy and safety of QVA149 (indacaterol/glycopyrrolate) versus its monocomponents and placebo in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2015;192(9):1068–1079. https://doi.org/10.1164/rccm.201505-1048OC Crossref, Medline, Google Scholar
Malhatra S, Shafique N. Bronchodilators. In: Jindal SKShankar PSRaoof SGupta DAggarwal ANAgarwal R (eds). Textbook of pulmonary critical care medicine, volume 1 and 2. London: JP Medical Publishers; 2011:926–933 Google Scholar
Masterton RG, Burley CJ. Randomized, double-blind study comparing 5-and 7-day regimens of oral levofloxacin in patients with acute exacerbation of chronic bronchitis. Int J Antimicrob Agents. 2001;18(6):503–512. https://doi.org/10.1016/S0924-8579(01)00435-6 Crossref, Medline, Google Scholar
McFadden R. Introducing pharmacology for nursing and healthcare. 2nd edn. London: Routledge; 2014 Google Scholar
McIvor RA, Devlin HM, Kaplan A. Optimizing the delivery of inhaled medication for respiratory patients: the role of valved holding chambers. Can Respir J. 2018;2018:5076259. https://doi.org/10.1155/2018/5076259 Crossref, Medline, Google Scholar
McLafferty E, Johnstone C, Hendry C, Farley A. Respiratory system part 1: pulmonary ventilation. Nurs Stand. 2013;27(22):40–47. https://doi.org/10.7748/ns2013.01.27.22.40.e4216 Crossref, Medline, Google Scholar
Melani AS. Long-acting muscarinic antagonists. Expert Rev Clin Pharmacol. 2015;8(4):479–501. https://doi.org/10.1586/17512433.2015.1058154 Crossref, Medline, Google Scholar
Miravitlles M, Kruesmann F, Haverstock D, Perroncel R, Choudhri SH, Arvis P. Sputum colour and bacteria in chronic bronchitis exacerbations: a pooled analysis. Eur Respir J. 2012;39(6):1354–1360. https://doi.org/10.1183/09031936.00042111 Crossref, Medline, Google Scholar
Nakpheng T, Songkarak S, Suwandecha T, Sritharadol R, Chunhachaichana C, Srichana T. Evidences for salbutamol metabolism by respiratory and liver cell lines. Drug Metab Pharmacokinet. 2017;32(2):127–134. https://doi.org/10.1016/j.dmpk.2016.11.006 Crossref, Medline, Google Scholar
National Institute for Health and Care Excellence. Chronic obstructive pulmonary disease quality standard. Quality Standard 10. 2011. https://www.nice.org.uk/guidance/QS10/ (accessed 25 June 2020) Google Scholar
National Institute for Clinical Excellence. Chronic obstructive pulmonary disease in over 16s: diagnosis and management. NICE guideline 115. updated 2019. https://tinyurl.com/y3yftxc5 (accessed 25 June 2020) Google Scholar
Nau R, Sörgel F, Eiffert H. Penetration of drugs through the blood-cerebrospinal fluid/blood-brain barrier for treatment of central nervous system infections. Clin Microbiol Rev. 2010;23(4):858–883. https://doi.org/10.1128/CMR.00007-10 Crossref, Medline, Google Scholar
Newman SP, Pavia D, Garland N, Clarke SW. Effects of various inhalation modes on the deposition of radioactive pressurized aerosols. Eur J Respir Dis Suppl. 1982;119:57-65. Medline, Google Scholar
O'Donnell DE, Parker CM. COPD exacerbations. 3: pathophysiology. Thorax. 2006;61(4):354–361. https://doi.org/10.1136/thx.2005.041830 Crossref, Medline, Google Scholar
Porth CM. Essentials of pathophysiology. 4th edn. Philadelphia (PA): Wolters Kluwer Health; 2015 Google Scholar
Quon BS, Gan WQ, Sin DD. Contemporary management of acute exacerbations of COPD: a systematic review and metaanalysis. Chest. 2008;133(3):756–766. https://doi.org/10.1378/chest.07-1207 Crossref, Medline, Google Scholar
Rodríguez-Roisin R. COPD exacerbations. 5: management. Thorax. 2006;61(6):535–544. https://doi.org/10.1136/thx.2005.041863 Crossref, Medline, Google Scholar
Sanchis J, Gich I, Pedersen S; Aerosol Drug Management Improvement Team (ADMIT). Aerosol drug management improvement team. Systematic review of errors in inhaler use: has patient technique improved over time? Chest. 2016;150(2):394–406. https://doi.org/10.1016/j.chest.2016.03.041 Crossref, Medline, Google Scholar
Schneeberger EE, Lynch RD. The tight junction: a multifunctional complex. Am J Physiol Cell Physiol. 2004;286(6):C1213–C1228. https://doi.org/10.1152/ajpcell.00558.2003 Crossref, Medline, Google Scholar
Sears MR, Lötvall J. Past, present and future—beta2-adrenoceptor agonists in asthma management. Respir Med. 2005;99(2):152–170. https://doi.org/10.1016/j.rmed.2004.07.003 Crossref, Medline, Google Scholar
Shapiro SD, Reilly JJ, Rennard SI. Chronic bronchitis and emphysema. In Mason JRBroaddus VCMartin TRet al. (eds). Murray, and Nadel's textbook of respiratory medicine. 5th edn. Philadelphia (PA): Elsevier Saunders; 2010: 919–967 Crossref, Google Scholar
Skidmore-Roth L. Mosby's drug guide for nursing students. 11th edn. St Louis (MO): Elsevier; 2015 Google Scholar
Tam A, Sin DD. Pathobiologic mechanisms of chronic obstructive pulmonary disease. Med Clin North Am. 2012;96(4):681–698. https://doi.org/10.1016/j.mcna.2012.04.012 Crossref, Medline, Google Scholar
Turner MO, Patel A, Ginsburg S, FitzGerald JM. Bronchodilator delivery in acute airflow obstruction. A meta-analysis. Arch Intern Med. 1997;157(15):1736–1744. https://doi.org/10.1001/archinte.1997.00440360162018 Crossref, Medline, Google Scholar
Vallerand AH, Sanoski CA, Deglin JH. Davis's drug guide for nurses. 14th edn. Philadelphia (PA): FA Davis Company; 2015 Google Scholar
van Geffen WH, Douma WR, Slebos DJ, Kerstjens HAM. Bronchodilators delivered by nebuliser versus pMDI with spacer or DPI for exacerbations of COPD. Cochrane Database Syst Rev. 2016;29(8):CD011826. https://doi.org/10.1002/14651858.CD011826.pub2 Google Scholar
Vincken W, Levy ML, Scullion J, Usmani OS, Dekhuijzen R, Corrigan CJ. Spacer devices for inhaled therapy: why use them, and how? ERJ Open Res. 2018;4(2):00065-2018. https://doi.org/10.1183/23120541.00065-2018 Crossref, Medline, Google Scholar
Vollenweider DJ, Jarrett H, Steurer-Stey CA, Garcia-Aymerich J, Puhan MA. Antibiotics for exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2012;12:CD010257. https://doi.org/10.1002/14651858.CD010257 Medline, Google Scholar
Waller DG, Sampson AP, Renwick AG, Hillier K. Medical pharmacology and therapeutics. 4th edn. London: Elsevier; 2014 Google Scholar
Wedzicha JA, Seemungal TAR. COPD exacerbations: defining their cause and prevention. Lancet. 2007;370(9589):786–796. https://doi.org/10.1016/S0140-6736(07)61382-8 Crossref, Medline, Google Scholar
Wedzicha JA, Decramer M, Seemungal TA. The role of bronchodilator treatment in the prevention of exacerbations of COPD. Eur Respir J. 2012;40(6):1545-1554. https://doi.org/10.1183/09031936.00048912 Crossref, Medline, Google Scholar
Wedzicha JA, Decramer M, Ficker JH et al.. Analysis of chronic obstructive pulmonary disease exacerbations with the dual bronchodilator QVA149 compared with glycopyrronium and tiotropium (SPARK): a randomised, double-blind, parallel-group study. Lancet Respir Med. 2013;1(3):199–209. https://doi.org/10.1016/S2213-2600(13)70052-3 Crossref, Medline, Google Scholar
West JB. Pulmonary pathophysiology: the essentials. 9th edn. Philadelphia (PA): Wolters Kluwer Health; 2012 Google Scholar
Wilkinson TMA, Hurst JR, Perera WR, Wilks M, Donaldson GC, Wedzicha JA. Effect of interactions between lower airway bacterial and rhinoviral infection in exacerbations of chronic obstructive pulmonary disease. Chest. 2006;129(2):317–324. https://doi.org/10.1378/chest.129.2.317 Crossref, Medline, Google Scholar
Wilson R. Bacteria, antibiotics and COPD. Eur Respir J. 2001;17(5):995–1007. https://doi.org/10.1183/09031936.01.17509950 Crossref, Medline, Google Scholar
Wilson R. Short course of antibiotic treatment in acute exacerbations of COPD. Thorax. 2008;63(5):390–392. https://doi.org/10.1136/thx.2007.092932 Crossref, Medline, Google Scholar
Woo TM. Drugs affecting the respiratory system. In: Woo TMRobinson MV (eds). Pharmacotherapeutics for advanced practice nurse prescribers. 4th edn. Philadelphia (PA): FA Davis Company; 2016:361–415 Google Scholar
Woodhead M, Blasi F, Ewig S et al.; European Respiratory Society; European Society of Clinical Microbiology and Infectious Diseases. Guidelines for the management of adult lower respiratory tract infections. Eur Respir J. 2005;26(6):1138–1180. https://doi.org/10.1183/09031936.05.00055705 Crossref, Medline, Google Scholar
World Health Organization. Chronic obstructive pulmonary disease (COPD). 2020. https://www.who.int/respiratory/copd/burden/en/ (accessed 25 June 2020) Google Scholar
Yagiela JA, Dowd FJ, Johnson B, Mariotti A, Neidle EA. Pharmacology and therapeutics for dentistry. 6th edn. St Louis (MO): Elsevier; 2011 Google Scholar

9 July 2020Volume 29Issue 13

ISSN (print): 0966-0461
ISSN (online): 2052-2819

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Accepted 1 June 2020

Published online 10 July 2020

Published in print 9 July 2020

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