Chronic Obstructive Pulmonary Disease and Climate-Control Strategies

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Comparative study of beta 2 agonist and anticholinergic therapy in patients with stable Chronic Obstructive Pulmonary Disease.


Chronic Obstructive Pulmonary Disease (COPD) is one of the most

common diseases worldwide.1 According to GOLD (Global Initiative for

Obstructive Lung Diseases), definition COPD is a disease characterized by

airflow limitation that is not fully reversible. The airflow limitation is both

progressive and associated with an abnormal response of lungs to noxious

particles or gases.2 It includes chronic bronchitis and emphysema.

Chronic bronchitis is characterized by productive cough for three

months or more in at least two consecutive years in the absence of any other

disease that might account for this symptom. Emphysema denotes abnormal,

permanent enlargement of air spaces distal to terminal bronchiole, with

destruction of their walls and without obvious fibrosis.3

Causes of COPD include smoking, air pollution, occupational exposure

and genetic factors (including 1-antitrypsin deficiency). Chronic bronchitis

is responsible for 85% and emphysema for 15%of COPD patients.4


COPD is a leading cause of chronic morbidity and mortality and is a

major public health concern. The World Health Organization (WHO) estimates

that there are approximately 1.1 billion smokers in the world. The use of

biomass fuel, such as wood , for cooking increases the risk of COPD

by three to four times and is an contributor to COPD prevalence for some

parts of the world, particularly in developing countries and rural areas.

Air pollution increases the prevalence of COPD by an estimated 2% -for

each 10µg increase in particulate matter—10/m3. The WHO has published

data placing the worldwide prevalence of COPD at 0.8%. Other reports

place the prevalence of COPD substantially higher, at approximately 4 to 6%.5

In India there are about 200 million smokers. Use of wood, dried dung,

Crop residue and agricultural wastes as fuel for cooking leads to smoke causing

obstructive pulmonary disease.6

In Kashmir cold climatic conditions and use of wood, saw dust, coal

and coke for heating purposes leads to smoky environment and results in

common incidence of COPD.


Pharmacological management helps to prevent and control symptoms,

reduce the severity, frequency of exacerbations and improve health status

and exercise tolerance.7

These agents include anticholinergics like Ipratopium bromide,

sympathomimetic drugs like Beta-2 agonists, and Methyl xanthenes like


Inhaled anticholinergic drugs are often recommended for use as a first-

line therapy for patients with COPD because they provide similar or more

effective bronchodilating actions, as well as fewer side effects, as compared

to other bronchodialators8 and have lower costs and a greater number of

complication-free months compared with those taking theophylline.9

They act on muscarinic receptors(M3) on bronchial smooth muscles by

blocking hyperactive neural reflex which is mediated by vagus.10

Beta-2 agonists are the commonest prescribed medications in

respiratory practice.11 They produce their pharmacological effect by acting

on beta-2 receptors but because of their wide distribution, a number of side

effects occur common among which are tremor and palpitation. 3

These are more common with oral than with inhalation agents a reason for

preferential use of inhalation beta-2 agonists.12

Among methylxanthines, theophylline is commonly used in the

treatment of COPD. In vitro they inhibit phosphodiestrase resulting in higher

concentration of c-AMP causing bronchodialation. Another mechanism is the

inhibition of cell surface receptors for adenosine.13

Adverse effects of theophylline are varied and...
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