Respiratory
COPD (Chronic Obstructive Pulmonary Disease)
سی او پی ڈی
Chronic cough, breathlessness and wheeze in a chain smoker or passive smoker, with rhonchi on the chest. Treated with a steroid taper, a PPI, antibiotics when indicated, expectorants and nebulization.
- ICD-10
- —
- Source
- OPD handbook pp.40–43
- Status
- Draft
Not yet reviewed by a clinician. Check doses and brands against current national guidelines before use.
Symptoms
- Cough
- Shortness of breath (SOB)
- Wheezing
- Chain smoker / passive smoking
Diagnosis
- Rhonchi positive on the chest
- Differential diagnosis: bronchial asthma
Treatment
Step 1 of 7
1. Steroids: start and taper off
Choice: prednisolone.
- Prednisolone (Rapicort / Deltacortil), dexamethasone (Decadron / D-Cort) or betamethasone (Betnelan / Betnisol)
- Tapering schedule in the book, each step for 10 days: 4+4, then 3+3, then 2+2, then 1+1, then 1+0 (morning and evening)
Prescription
PrednisoloneCorticosteroid
Dose4+4 × 10 days, 3+3 × 10 days, 2+2 × 10 days, 1+1 × 10 days, 1+0 × 10 days
Brand Tab Rapicort EC 5 mg
Taper
Also sold as Deltacortril, Rapicort, Rapicort EC, Prednisolone 5 mg
DexamethasoneCorticosteroid
Dosealternative steroid
Brand Decadron / D-Cort
Also sold as Decadron, Dexa, D-Cort
BetamethasoneCorticosteroid
Dosealternative steroid
Brand Betnelan / Betnisol
Also sold as Betnisol, Betnelan
Step 2 of 7
2. PPI (to prevent steroid-induced GI toxicity)
- Dose: 40 mg OD, or 20 mg BD
Prescription
OmeprazoleProton pump inhibitor
DoseCap Risek 40 mg 1+0, or Cap Ruling 20 mg 1+1
Brand Teph / Risek / Ruling
Also sold as Risek, Teph, Ruling, Ruling sachet, Omega
EsomeprazoleProton pump inhibitor
Dose40 mg OD or 20 mg BD
Brand Eskem / Novoteph / Esante
Also sold as Novoteph, Esante, Eskem, Eswin, Nexum, Esso, Exium
Step 3 of 7
3. Antibiotics (if indicated)
- Indication: the patient is febrile, or has greenish / yellowish sputum
Prescription
LevofloxacinFluoroquinolone antibiotic
Dose250 mg 1+1
Brand Tab L-Cyn
Also sold as L-Cyn, Leflox, Efflox (spelling unclear in book), Levo
Amoxicillin + Clavulanic acidPenicillin antibiotic + β-lactamase inhibitor
Dose625 mg 1+1+1
Brand Augmentin
Also sold as Augmentin, Co-Amoxiclave, Calamox
Caution: Penicillin allergy; Cholestatic jaundice risk with prolonged use
Cefixime3rd-generation cephalosporin
Dose400 mg 1+0
Brand Caricef
Also sold as Cefspan, Cefim, Caricef, Tixomer, Cefiget
Rising resistance in Salmonella Typhi; not reliable as a sole agent in XDR typhoid.
MoxifloxacinFluoroquinolone antibiotic
Dose400 mg 1+0
Brand Mofest
Also sold as Mofest, Moxef, Avelox, Moxiget
Step 4 of 7
4. Expectorants (remove sputum)
Prescription
Terbutaline (expectorant/bronchodilator syrup)Beta-2 agonist
Dose2 tsf TDS
Brand Syp Britanyl / Muconyl
Also sold as Britanyl, Bricanyl, Muconyl
Hydraline syrup (bronchodilator cough syrup, as written)Bronchodilator / expectorant syrup
Dose2 tsf TDS
Brand Syp Hydraline
Step 5 of 7
5. Nebulization
- Nebulize with N/S QID
- Nebulize with Clenil QID
Prescription
Normal saline nebulization (0.9%)Nebulization / mucolytic support
DoseN/S QID
Brands Generic / hospital supply
Step 6 of 7
6. Inhalers (advanced; also used in asthma)
Prescription
Budesonide + Formoterol (inhaler)ICS + LABA inhaler
Doseas per Urdu note in the book
Brand Inh Combivair 100/6
Tiotropium (inhaler)Long-acting anticholinergic
Doseas per Urdu note in the book
Brand Inh Tiovair 18 mcg
Step 7 of 7
7. Counselling
- Quit cigarette smoking: constant cigarette smoke narrows the airways, phlegm collects in the chest and causes breathlessness
- Wear a mask
- Use vegetables and fruits
Sample prescription from the book (patient details removed)
- Male, 55 y, cough and SOB for 1 year, known smoker for 30 years, now fever and productive cough; rhonchi positive: Tab L-Cyn 250 mg 1+1; Tab Rapicort EC 5 mg 4+4; Cap Ruling 20 mg 1+1; Syp Britanyl 2+2+2 spoonfuls; quit cigarettes; steam inhalation; wear a mask; review after 5 days.