1. Lynn Helliwell

2. About Me!
Practice Nurse
Respiratory Lead
NMCCG

6. Make a list of as many groups of drugs you know in both ASTHMA and COPD

7. Asthma Short- acting beta agonist
Salbutamol
AiromirRo,
SalamolR□,
VentolinR□
AsmasalR
Salbulin
Terbutaline
Bricanyl

8. Asthma Inhaled corticosteroid
Beclomethasone
Asmabec
Clenil modulite
Beclometasone Extrafine
Qvar
Fluticasone
Flixotide
Budesonide
pulmicort
Budelin
Mometasone furate
(asmanex twisthaler)

9. Asthma Long Acting beta agonist Formoterol (Oxis) – twice daily
Salmeterol (serevent)- twice daily
Tiotropium (respimat )- daily

10. Combination inhalers Seretide Flutiform
Fluticasone priopionate/salmeterol
Flutiform
Fluticasone/formoterol
Symbicort and Duoresp (these are different devices)
Budesonide / formoterol
Fostair
Beclomethasone Extra fine/formoterol
Relvar
Fluticasone Furoate /Vilanterol
Fluticasone Furoate /Vilanterol

12. Asthma Symbicort over 6yrs Duoresp Over 18rys Seretide over 5yrs
Turbohaler
Duoresp Over 18rys
Easybreathe /spiromax
Seretide over 5yrs
MDI + Accuhaler
Fostair over 18yrs
MDI + Nexthaler
Flutiform over 12yrs
MDI
Relvar over 12yrs
Ellipta see notes

13. Relvar Ellipta is licensed for the regular treatment of asthma in adults and adolescents aged 12 years and older where use of a combination medicinal product (LABA and ICS) is appropriate, that is patients not adequately controlled with ICS and 'as needed' inhaled short-acting beta‑2 agonists. It is not licensed for use in patients who are already adequately controlled on both an ICS and a LABA, unlike the other 4 ICS/LABA combination inhalers that are licensed in the UK for the treatment of asthma. Nice guidelines March14

14. COPD Short acting bronchodilators Short acting anti-muscarinics
Salbutamol
Terbutaline
Short acting anti-muscarinics
Atrovent

15. COPD Long acting Beta2 agonist
Salmeterol
Serevent accuhaler + MDI
Inderacterol
Onbrez Breezhaler
Formoterol easyhaler
Oxis, turbohaler
Atimos modulite, Dry powder
Foradil MDI
Olodaterol
Striverdi RESPIMAT
Vilanterol ellipta

16. COPD LONG ACTING ANTI-MUSCARINIC
Tiotropium
spiriva respimat + Handihaler
Glycopyrronium
Seebri Breezhaler
Aclidinium Bromide
Eklira Genuair
Umeclidinium
Incruse ® Ellipta ®

17. COPD Combination antimuscarinic + long acting beta2agonist
Umeclidinium bromide/Vilanterol
Anoro Ellipta GSK
Aclidinium bromide/formoterol fumerate dihydrate)
Duklir Genuair
Indacterol/glycopyrronium
Ultribro Breezhaler
Tiotropium/olodaterol
Spiolto Respimat

18. COPD Combination ICS/LABA
Beclometasone extra fine/Formoterol 100/6
Fostair (mDI) puffs bd
Budesonide/formoterol 400/12
Symbicort turbohaler puff bd
Budesonide/formoterol 320/9
Duoresp spiromax puff bd
Fluticasone/Salmeterol 500
Seretide accuhaler puff bd
Fluticasone Furoate /Vilanterol 92/22
Revlar Ellipta daily

19. Black triangle drugs
The black triangle identifies newly licensed medicines that require additional monitoring by the European medicines Agency (E.M.A) Such medicines include new active substances, biosimilar medicines and medicines that the E.M.A consider require additional monitoring. The black triangle symbol appears in the Pt. information leaflet for relevant medicines ,with a brief explanation of what it means. Products usually retain a black triangle for 5yrs but this can be extended if needed. ( BNF march15)

20. Sources of Information
Nursing magazines :
Independent
Practice
BNF
Drug company websites
Greater Manchester medicines management group

21. Key facts
Asthma costs the NHS £1 billion a year with 75% of the admissions being avoidable saving a possible £44 million
Asthma can cause disability and 3 people per day die of it
Asthma cannot be cured but can be managed
Upto 5.4 million people in the uk suffer from asthma

22. Key Facts
More than five million people in the UK are being treated for asthma
Many emergency admissions are believed to be avoidable
Up to 200,000 people in the North West have undiagnosed asthma

24. http://www. theguardian
Looks at where we sit in deaths

25. What it found 23% (44/197) has PAP
43% (84/197) had not had a primary care review within the last 12/12
50% had documented triggers/exacerbating factors.
39% severe asthma, 49% moderate asthma, 9% mild asthma.
If asthma guidelines where utilised 46% avoidable deaths
Of 155 who severtiy was given 39% severe asthma, 49% moderate asthma, 9% mild asthma ? Poorly controlled rather than mild/moderate disease
If asthma guidelines where utilised 46% avoidable deaths, lak of asthma knowledge and guidelines.

26. What have we learnt to date?/historical studies
Refer to previous papers, still hant learnt

27. Key recommendations – Medical and professional care
PAP for all
Annual review of all asthma patients by person trained in asthma management. More so in severe.
Routine documentation of triggers exacerbating factors
Assessment of asthma control at each review
Increased awareness in patients with Psychological, mental health issues.

28. Management plans should encompass:
Structured education, reinforced with a written PAAP (personal asthma action plans)
Specific advice re recognition of loss of control
symptoms or peak flow or both
What they must do if increase in symptoms and asthma deteriorates
Need to get patient on board with plan (theirs not yours)
Asthma UK