COPD Alison Boland StR Respiratory medicine. Aims & Objectives Overview of COPD Recap basic knowledge Update on COPD Know when to use nebulisers and home.

Slides:



Advertisements
Similar presentations
Definition of COPD COPD is a preventable and treatable disease with some significant extrapulmonary effects that may contribute to the severity in individual.
Advertisements

GOLD MANAGEMENT PLAN FOR CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)
CHRONIC OBSTRUCTIVE PULMONARY DISEASE Treatment Opportunities in a Heartsink Disease Jim Reid.
Obstructive Airways Disease Asthma and COPD Dr H Ahmad VTS 29/04/2009.
Clinical Knowledge Summaries CKS Chronic obstructive pulmonary disease (COPD) - management Management of stable COPD in primary care, focusing on drug.
Dr. Danny Galdermans Dept Respiratory Medicine ZNA Middelheim Antwerp
By: E. Salehifar Clinical Pharmacist
Chronic Obstructive Pulmonary Disease Natasha Chowdhury.
Definition of COPD COPD is a preventable and treatable disease with some significant extrapulmonary effects that may contribute to the severity in individual.
COPD Joshua Jewell. Epidemiology 8% of all individuals 10% age >40 6 th leading cause of death worldwide th in U.S. - >120,000 Expected 3 rd 2020.
Chronic obstructive pulmonary disease (COPD) Professor Bill MacNee
COPD GUIDELINES Sarah Cowdell. WHY GUIDELINES MATTER Predicted to be the third leading cause of death by 2030 Cause of over 30,000 deaths in the UK yearly.
Chronic Obstructive Pulmonary Disease and Asthma: All That Wheezes? Clifford Courville, MD Pulmonary, Allergy, and Critical Care.
COPD Management of Stable COPD Shyam Rao May 2014.
1 British Guideline on the Management of Asthma BTS/SIGN British Guideline on the Management of Asthma, May 2008 Introduction Diagnosis Non-pharmacological.
Week 4: Asthma and COPD Dr Felix Woodhead Consultant Physician.
Asthma Management Fine Tuning  Maximum control with minimum medication  Start with mild asthma and work up the scale (BTS/SIGN 2004)
Chronic Obstructive Pulmonary Disease. What will we cover? Diagnosis Management of stable COPD Management of exacerbations of COPD.
Chronic Obstructive Pulmonary Disease. Why COPD is Important ? COPD is the only chronic disease that is showing progressive upward trend in both mortality.
GOLD Website Address
Habib GHEDIRA, MD, Prof. Medical Faculty of Tunis
© 2013 Global Initiative for Chronic Obstructive Lung Disease
Bronchial Asthma  Definition  Patho-physiology  Diagnosis  Management.
Respiratory COPD/Asthma.
Bronchial Asthma  Definition  Patho-physiology  Diagnosis  Management.
How can COPD Community Services reduce hospital admissions? Glenda Esmond Respiratory Nurse Consultant West Herts Community COPD Service.
0 Chronic obstructive pulmonary disease Implementing NICE guidance 2 nd Edition July 2011 NICE clinical guideline 101.
يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11 بسم الله الرحمن الرحیم با سلام.
 Definition  Asthma is a chronic inflammatory disorder of the lung airways, characterised by reversible airway obstruction, airway hyper-responsiveness,
Medicines optimisation can help reduce COPD related hospital admissions and exacerbations - LCH MMT Approach Alison McMinn Respiratory Lead Pharmacist.
Definition COPD def- A disease state characterized by air flow limitation that is not fully reversible It is expected to be the 3 rd leading cause of.
GOLD Update 2011 Rabab A. El Wahsh, MD. Lecturer of Chest Diseases and Tuberculosis Minoufiya University REVISED 2011.
Component 1: Measures of Assessment and Monitoring n Two aspects: –Initial assessment and diagnosis of asthma –Periodic assessment and monitoring.
Andriy Lepyavko, MD, PhD Department of Internal Medicine № 2.
Aaqid Akram MBChB (2013) Clinical Education Fellow
COPD Diagnosis & Management Anil Ramineni Specialist Respiratory Physiotherapist Community Respiratory Team.
Home Care of Chronic Obstructive Pulmonary Disease Patients.
Chronic Obstructive Pulmonary Disease Austin Paul K.
Exacerbations. Exacerbations An exacerbation of COPD is an acute event characterized by a worsening of the patient’s respiratory symptoms that is beyond.
© IPCRG 2007 COPD -Management of stable disease WONCA meeting Istanbul October 2015 Svein Høegh Henrichsen Oslo, Norway.
Severe breathlessness
Andriy Lepyavko, MD, PhD Department of Internal Medicine № 2.
Maggie Harris Independent Respiratory Nurse Specialist
History Taking Zinc code: UKACL1878ea Date of preparation May 2015 AstraZeneca provided funding & reviewed for technical accuracy.
Asthma Guidelines, Diagnosis and Management Alison Hughes Respiratory Specialist Nurse Solent NHS Trust.
Wendy Pigg Practice support Pharmacist/Independent Prescriber
Prescribing for patients with COPD Evidence Update Emma Blanden- Pharmacist.
Chronic Obstructive Pulmonary Disease. COPD is an umbrella term for two diseases which cause progressive airflow obstruction Chronic Bronchitis- Inflammation.
Definition Chronic obstructive pulmonary disease (COPD) is characterized by chronic airflow limitation and a range of pathological changes in the lung.
Management of stable chronic obstructive pulmonary disease (2) Seminar Training Primary Care Asthma + COPD D.Anan Esmail.
COPD Emergency Department Junior Medical Staff Teaching August 2015.
PULMONARY REHABILITATION.
GOLD 2017 major revision: Summary of key changes
Current management of COPD and when to refer?
Pulmonary Center of Excellence
COPD 2003.
Chronic Obstructive Pulmonary Disease(COPD)
COPD – Primary Care Update
COPD PATHWAY AND PRESCRIBING POLICY IN LAMA options (stop SAMA):
Medicines Management – COPD update for LPC Jyoti Saini Hema Patel
COPD By Alaina Darby.
COPD Dr MAMATHA SARTHI GPST3.
بیماریهای مزمن انسدادی ریه COPD
20 minute update Asthma and COPD
Management of Chronic Stable COPD
Gestione clinica della BPCO
Chronic Obstructive Pulmonary Disease
Nottinghamshire COPD and Asthma Guidelines
Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification based on symptom and risk evaluation. a) GOLD model of symptom/risk evaluation.
PALLIATIVE CARE FOR COPD PATIENTS:
Presentation transcript:

COPD Alison Boland StR Respiratory medicine

Aims & Objectives Overview of COPD Recap basic knowledge Update on COPD Know when to use nebulisers and home oxygen therapy The role of NIV in palliative setting / end stage COPD Gain patient, carer and personal view about COPD

GOLD Definition Airflow limitation Not fully reversible Progressive Abnormal inflammatory response to noxious particles or gases

CHRONIC Develops slowly Early symptoms often go un-noticed Symptoms present for much of the time Progressive dyspnoea over time. Worse on exercise

OBSTRUCTIVE Narrowing of the bronchi 3 mechanisms: Bronchial walls become weakened Mucus secretion into the bronchi. Muscle spasm

Natural History

Activity BREATHE THROUGH THE STRAW FOR A MINUTE THNIK ABOUT HOW THIS FEELS.

Diagnosis FEV1/FVC <70% Post bronchodialator FEV1 <80% predicted. FEV1/FVC more sensitive.

Diagnose COPD: assessment of severity Assess severity of airflow obstruction using reduction in FEV 1 NICE clinical guideline 12 (2004) ATS/ERS 2004GOLD 2008NICE clinical guideline 101 (2010) Post- bronchodilator FEV 1 /FVC FEV 1 % predicted Post- bronchodilator < 0.780%MildStage 1 (mild)Stage 1 (mild)* < 0.750–79%MildModerateStage 2 (moderate) < 0.730–49%ModerateSevereStage 3 (severe) < 0.7< 30%SevereVery severeStage 4 (very severe)** * Symptoms should be present to diagnose COPD in people with mild airflow obstruction ** Or FEV 1 < 50% with respiratory failure [new 2010]

Patient with COPD Palliative care SmokingBreathlessness & exercise limitation Frequent exacerbations Respiratory failure Cor pulmonale Abnormal BMI Chronic productive cough Anxiety & depression Managing stable COPD Assess symptoms/problems Manage those that are present as below Patients with COPD should have access to the wide range of skills available from a multidisciplinary team

Treatment options Pharmacological Bronchodilators Steroids Antibiotics Mucolytics Antitussives Narcotics

Treatment options Non – pharmacological Pulmonary rehabilitation Oxygen NIV Surgery Bullectomy Lung volume reduction surgery Lung transplantation

Managing stable COPD: inhaled therapies SABA or SAMA as required* Breathlessness and exercise limitation Exacerbations or persistent breathlessness Persistent exacerbations or breathlessness LABALAMA Discontinue SAMA ________ Offer LAMA in preference to regular SAMA four times a day LABA + ICS in a combination inhaler ________ Consider LABA + LAMA if ICS declined or not tolerated LAMA Discontinue SAMA ________ Offer LAMA in preference to regular SAMA four times a day FEV 1 ≥ 50% FEV 1 < 50% LABA + ICS in a combination inhaler ________ Consider LABA + LAMA if ICS declined or not tolerated LAMA + LABA + ICS in a combination inhaler OfferConsider * SABAs (as required) may continue at all stages

Bronchodilators Individual effects unpredictable Inhaled: Salbutamol (‘Ventolin’) Ipatropium (‘Atrovent’) Salmeterol (Serevent) Terbutaline (‘Bricanyl’) Tiotropium (‘Spiriva’) Indacterol (‘onbrez) Oral: Theophyllines (‘Uniphyllin’, ‘Phyllocontin’)

Inhaler technique!!

Steroids Inhaled – Seretide, Symbicort Oral prednisolone Do not modify long term decline in FEV1

Oral therapy Theophylline Carbocisteine Opioids Anti anxiolytics

Nebulisers On maximum medical therapy Use salbutamol only 1 month trial No improvement in symptoms then stop

New(ish) therapies Indacterol Roflumilast (Azithromycin)

Indacaterol Long acting Beta agonist Rapid onset of action 24 hr duration of action 150micrograms od Future use as add on to tiotropium

Phosphodiesterase inhibitors Roflumilast Severe COPD (FEV1 <50%) Hx Chronic bronchitis, frequent exacerbations 500micrograms od Reduces rate of moderate to severe exacerbations

Azithromycin Macrolide antibiotic Recurrent exacerbations On maximum therapy Long term 250mg x3 week Caution re side effects

Oxygen provision Long term oxygen therapy Ambulatory oxygen Short burst oxygen

LTOT FEV1 <50% predicted OR < 1.5l Signs of cor pulmonalae Sats <92% PO2 <7.3 (8kPa) Drying of nasal passages, oxygen toxicity, Palliative care – target saturations not indicated

Ambulatory Oxygen O2 use during exercise /ADL LTOT patients Objective evidence of desaturation on exercise

Short burst oxygen Or Palliative O2 To relieve SOB Excludes LTOT & ambulatory oxygen users

HOOF

Non invasive ventilation Home NIV Recurrent acute type 2 respiratory failures Intolerance LTOT Increased co2 with symptoms Overlap OSA / Obesity hypoventialtion End of life care

Chronic disease management Stop smoking Prn Bronchodilator Annual flu jab Pneumococcal vaccine (5yrs) Regular exercise Maintain weight normal range

Nutrition Underweight usually BMI <20 Assess co morbidities Social factors Encourage snacking, Higher fat foods Supplements after 1 month of above Dietician advise

Pulmonary rehab

SOB waking on level ground at normal pace 2hr sessions, 6 weeks Motivated patients

Patient views about COPD

Key Messages Consider Azithromycin in recurrent exacerbations Prescribe short burst O2 with caution – expensive and little evidence Pulmonary rehabilitation important multidisciplinary management Finally remember how breathing through a straw felt!

Any Questions?