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Content Update

July 30, 2019

Using C-Reactive Protein (CRP) Testing to Guide Antibiotic Use for COPD Exacerbations: Almost half of COPD patients experience one or more acute exacerbations of symptoms each year. Acute exacerbations are triggered by a variety of causes, including upper respiratory tract infections in 70% to 80% of cases. Most patients who present with acute worsening of COPD symptoms are treated with antibiotics, but antibiotic overuse contributes to antimicrobial resistance and increases the risk of adverse effects. Researchers in the United Kingdom used C-reactive protein (CRP) testing as a biomarker to assess acute COPD exacerbations and to guide antibiotic prescribing. The results suggest that using the results of point-of-care CRP tests could significantly reduce the number of antibiotics prescribed without adversely impacting COPD symptoms or hospitalization rates.

LEARNING OBJECTIVES

LEARNING OBJECTIVES

Upon completion of the chapter, the reader will be able to:

  1. Describe the pathophysiology of chronic obstructive pulmonary disease (COPD).

  2. Identify signs and symptoms of COPD.

  3. List the treatment goals for a patient with COPD.

  4. Design an appropriate COPD maintenance treatment regimen based on patient-specific data.

  5. Design an appropriate COPD exacerbation treatment regimen based on patient-specific data.

  6. Develop a monitoring plan to assess effectiveness and adverse effects of pharmacotherapy for COPD.

  7. Formulate an appropriate education plan for a patient with COPD.

INTRODUCTION

Chronic obstructive pulmonary disease (COPD) is a progressive disease characterized by airflow limitation that is not fully reversible. Previous definitions of COPD included chronic bronchitis and emphysema. Chronic bronchitis is defined clinically as a chronic productive cough for at least 3 months in each of two consecutive years in a patient in whom other causes have been excluded.1 Emphysema is defined pathologically as destruction of alveoli.1 The major risk factor for both conditions is cigarette smoking, and many patients share characteristics of each one. Therefore, current guidelines focus instead on chronic airflow limitation.

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) is an expert panel of health professionals who developed consensus guidelines for the diagnosis and care of patients with COPD that are updated annually.1

EPIDEMIOLOGY AND ETIOLOGY

COPD is a major cause of morbidity and mortality and a significant cause of disability worldwide. In 2013, 15.7 million US adults were estimated to have COPD.2 Chronic lower respiratory diseases are the third leading cause of death in the United States. In 2014, more than 151,000 adults died from COPD.3 Personal health care spending in the United States on COPD was estimated to be $53.8 billion in 2013.4

COPD is caused by repeated inhalation of noxious particles or gases, most commonly cigarette smoke. Marijuana and other forms of tobacco, including secondhand ...

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