However, Epinephrine and racemic epinephrine should not be used to treat COPD, as many newer agents with fewer side effects exist. These agents are available over-the-counter and marketed to individuals with breathing issues. Additionally, these agents can cause an increase in myocardial contractility and heart rate due to beta1-receptor stimulation. These agents possess a vasoconstricting effect to reduce airway swelling after extubation (stridor), croup, and epiglottitis. Additionally, beta-adrenergic agents containing alpha receptor properties may be used to treat upper airway conditions such as stridor, croup, and epiglottitis.3Įpinephrine and racemic epinephrine are often used for their alpha-receptor effects. These agents treat asthma, bronchitis, bronchiectasis, cystic fibrosis, and chronic obstructive pulmonary disease (COPD). The main indication for using a beta-adrenergic bronchodilator (Table 1) is to reverse airflow obstruction. In evaluating COPD for treatment, the best strategy is to use information from GOLD COPD.2 In Figure 1, you will find the ABCD assessment tool for the treatment of stable COPD. This review will cover the existing classes of drugs including, β2-agonists, anticholinergic agents, corticosteroids, and PDE4 selective inhibitors. Therefore, the use of an evidence-based strategy is best. The clinician may seek similar or different care plans in caring for chronic bronchitis and emphysema however, airflow is the central issue. Therefore, the accumulation of the mucus and an unproductive cough due to respiratory muscle weakness exacerbate symptoms of chronic bronchitis. Epithelial damage due to COPD-associated chronic inflammation and loss of lung elasticity cause difficulties in clearing the airway of mucus. The mucus is mainly produced by goblet cells, which act as the first line of defense for the respiratory tract and interact with the immune system. In addition to emphysema, patients with COPD often experience chronic bronchitis consequent to mucus accumulation in the lung. These changes keep the lungs from remaining open during expiration, limit airflow in the airway, reduce expiratory output, and cause dyspnea, a common symptom of difficult breathing. Emphysema, also known as parenchymal destruction, is characterized by abnormal permanent enlargement of air spaces distal to the terminal bronchiole, resulting in a loss of alveolar attachment and a decrease in the elasticity of the lungs. Chronic bronchitis is the inflammation of bronchial tubes leading to the narrowing of the small airways, which carry air in and out the air sacs (alveoli) in the lungs. The two most common clinical conditions of COPD include chronic bronchitis and emphysema. Although COPD prevalence continues to rise, strategies for prevention, treatment, and management of the disease are limited.
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