Management of Asthma and Chronic Airflow Limitation (Part 9)

These data indicate that patients with acute exacerbations of COPD may be treated effectively with a regimen of oxygen, antibiotics, corticosteroids and frequently administered, appropriately large doses of inhaled bronchodilators. Parenteral aminophylline, while adding considerably to side effects, probably confers no additional therapeutic benefit. Although bronchospasm may be partly responsible for worsening of airflow obstruction in exacerbations of COPD, other mechanisms such as edema, hypersecretion and impaired mucociliary transport associated with bronchial mucosal inflammation may play an equal or greater role. Hence, corticosteroids and occasionally antibiotics may be as or more important than bronchodilators in achieving resolution of the airflow obstruction associated with the acute illness — buy antibiotics online.
It has been suggested that methylxanthines may provide extrapulmonary benefits, such as inotropic effects on the myocardium and respiratory muscles.- Other investigators have failed to confirm these findings. Evidence for and against the extrapulmonary effects of methylxanthines have been summarized in a recent review. A recent study which showed that theophylline is of benefit by improving respiratory muscle function in patients with COPD, failed to comment on the occurrence of side effects in any of the patients. Since side effects are associated with theophylline administration, if, as was the case in this study, the serum theophylline is maintained in the therapeutic range it is likely that the patients studied were preselected. Thus, the findings in this study may be applicable only to selected patients. These extrapulmonary effects are of potential interest, and may represent the major beneficial effect in these patients.

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