1. Respiratory Health Asthma and COPD

2. Definition of asthma 2 Working definition by AAH 2014: Chronic lung disease Can be controlled not cured Large variation in lung function Large variation in respiratory symptoms Bronchioles are hyper responsive and narrowed due to mucus and oedema (excess fluid)

3. Some asthma facts 3 Australia has a high incidence of asthma About 1 in 10 Australians have asthma The rate is similar between adult men and women Boys have a higher rate of asthma than girls up till age 14, then it seems to be higher in girls

4. Symptoms 4 Dry cough (can be mainly at night in children) Wheezing Chest tightness Shortness of breath

5. What happens during an episode of asthma 5 Triggers make airways hypersensitive Airways become narrow and inflamed Extra mucus is produced – causes airways to swell up All this makes breathing difficult.

6. Causes of asthma 6 Heredity Linked to allergies e.g. hay fever, eczema Environmental triggers (including work-related asthma)

7. Trigger factors 7 Inhaled allergens e.g. pollen, dust mites, animal hair Inhaled irritants e.g. perfumes, air pollution Colds and flu Vigorous exercise Temperature changes Reflux disease Emotions Some medicines Work related triggers e.g. chemical fumes in factories, bakers’ flour dust, wood chip dust

8. Diagnosis 8 A doctor will diagnose asthma based on: Family history Symptoms patient is experiencing Lung function tests

9. Management of asthma 9 Avoid triggers Take medicines as prescribed Self awareness and self management

10. Asthma medicines 10 Short term medicines – for quick relief of symptoms Long term medicines – to maintain control and prevent flare up of asthma

11. Asthma medicines 11 Short term medicines – used only as needed –Inhaled bronchodilators like SABAs (short-acting beta agonists). Some examples are salbutamol, terbutaline –Oral corticosteroids e.g. prednisone/ prednisolone Long term medicines – used regularly –Inhaled corticosteroids (ICS) e.g. fluticasone, budesonide etc –Inhaled ICS/LABA (l ong-acting beta agonist ) combination –Other e.g. oral montelukast, omalizumab injection, theophylline, cromones

12. Self management Action plans – every person with asthma should have one Ask your customers if they have one (image source: National Asthma Council Australia) 12

13. Asthma in pregnancy and breastfeeding Treating asthma in pregnancy is important - untreated asthma puts baby at risk Safe medicines are available for asthma in pregnancy and breastfeeding No special diet required in pregnancy or during breastfeeding No evidence that prolonged exclusive breastfeeding will prevent asthma Hydrolysed soy or soy formula over breastfeeding just to prevent asthma is not recommended 13

14. What is COPD 14 COPD = Chronic Obstructive Pulmonary Disease Long-term lung disease Causes shortness of breath Includes emphysema, chronic bronchitis and chronic asthma No cure Progressive

15. Signs and Symptoms 15 Chronic productive cough Increased sputum production Breathlessness Tiredness Other symptoms e.g. chest tightness, wheezing, recurrent chest infections Symptoms get worse over time.

16. Risk factors for COPD 16 Smoking – primary cause Other causes: –air pollution (indoor and outdoor) –workplace exposure e.g. dust, chemical fumes

17. Management of COPD 17 Medicines (stepwise/step up approach) 1.SABAs or SAMAs as needed for symptom relief 2.LAMA (e.g. tiotropium) and/or LABAs everyday 3.ICS added only if poor lung function and >2 exacerbations in 12 months 4.Roflumilast or low dose theophylline may be considered Keep vaccinations up to date Pulmonary rehabilitation

18. COPD compared to asthma 18 AsthmaCOPD Risk factors Family history, allergies, triggers (e.g. pollen, air pollution, smoking), occupational exposure Smoking, air pollution, occupational dust and chemicals Age of onset Any age but usually diagnosed in children and young people Usually seen in older people Symptoms Wheeze, episodic shortness of breath, chest tightness Shortness of breath -worsens over time, productive cough Area affected Mainly airways (bronchioles, lungs) Affects airways, bronchioles, lungs and other body organs Lung function test – spirometry Reversibility seenNo reversibility observed Medicines SABAs used only as required Usually LAMA or LABA added if relief with SABA not achieved. In persistent asthma – regular ICS recommended. ICS/LABA combination added if symptoms persist. ICS/LABA combination reserved for patients who meet the exacerbation criteria Antibiotics rarely indicated for exacerbationsAntibiotics often required for exacerbations.

19. Types of inhalers 19 Design typeDeviceCommon medicines (brands) Standard pressurised metered dose inhaler (pMDI) Generic inhaler used alone or with spacer Relievers Salbutamol (Airomir, Asmol, Ventolin) Preventers Ciclesonide (Alvesco) Beclomethasone (Qvar) Budesonide and eformeterol (Symbicort Rapihaler) Fluticasone (Flixotide) Fluticasone and eformeterol (Flutiform) Nedocromil sodium (Tilade) Salmeterol and fluticasone (Seretide) Sodium cromoglycate (Intal, Intal Forte) Other bronchodilators Ipratropium bromide (Atrovent) Ipratropium plus salbutamol (Combivent) Design typeDeviceCommon medicines (brands) Breath actuated pMDI Autohaler Relievers Salbutamol (Airomir) Preventers Beclomethasone (Qvar) Dry powder inhaler (DPI) Accuhaler (breath- activated DPI) Preventers Fluticasone (Flixotide) Salmeterol and fluticasone (Seretide) Other Salmeterol (Serevent) Aerolizer Eformoterol (Foradile) Turbuhaler Relievers Terbutaline (Bricanyl) Preventers Budesonide (Pulmicort) Budesonide and eformoterol (Symbicort) Other Eformeterol (Oxis)

20. Inhaler technique 20 Common Mistakes in Inhalation Technique Breathing out while pressing the inhaler Not starting to breathe in while pressing the inhaler Inhaling too rapidly Not inhaling deeply Breathing through the nose Failing to hold breath after breathing in Pressing the inhaler more than once

21. Spacers 21 More medicine gets into the lungs with spacers than using pMDIs alone No hand-breath co-ordination required Use spacer for young children with pMDI (under 4 should also use mask) Use spacer for adults using ICS via pMDI to reduce oral thrush Shake pMDIs before each actuation (puff) One puff = one breath Wash plastic spacers in detergent and allowing to drip dry Check spacers every 6–12 months