Download presentation
Presentation is loading. Please wait.
Published byAmice Nelson Modified over 6 years ago
1
Medicines Management – COPD update for LPC Jyoti Saini Hema Patel
September 2017
2
Key issues Epidemiology
Tools to support clinicians with assessing symptoms Place in therapy for new drugs Update on new devices / inhalers Treatment pathway
3
Epidemiology About 3 million people have chronic obstructive pulmonary disease (COPD) in the UK Nearly 900,000 people in England and Wales are diagnosed as having COPD and an estimated 2 million people have COPD which remains undiagnosed In Walsall 2014/15 QoF reported COPD prevalence was 2.5% Symptoms usually develop insidiously making it difficult to determine the true prevalence of the disease Most patients are not diagnosed until they are in their fifties Chronic obstructive pulmonary disease (updated). Clinical guideline CG101: June. National Institute for Health and Clinical Excellence
4
COPD prevalence
5
COPD COPD is predominantly caused by smoking and is characterised by airflow obstruction that: - is not fully reversible - does not change markedly over several months - is usually progressive in the long term Exacerbations often occur, where there is a rapid and sustained worsening of symptoms beyond normal day-to-day variations requiring a change in treatment COPD produces symptoms, disability and impaired quality of life which may respond to pharmacological and other therapies that have limited or no impact on the airflow obstruction.
6
Natural History The Fletcher-Peto Diagram, illustrating the effects of smoking on rate of decline in FEV1 Fletcher C, Peto R, The natural history of chronic airflow obstruction, British Medical Journal, 1: , 1977.
7
Diagnosis of COPD Consider a diagnosis of COPD for people who are:
over 35, and are smokers or ex-smokers, and have any of these symptoms: exertional breathlessness chronic cough regular sputum production, frequent winter ‘bronchitis’ wheeze and no clinical features of asthma
8
COPD Assessment Test (CAT)
Validated, short (8-item) and simple patient completed questionnaire developed to measure health status of COPD patients Developed by multidisciplinary groups of international experts Has been validated in prospective studies and available in more than 50 languages Recommended that patients complete questionnaire when they arrive for their appointment or immediately before attending Has a scoring range of 0-40 and patients may complete every 2-3 months to detect changes and trends in CAT score
9
COPD Assessment Test (CAT)
10
CAT scores
11
Overview of management
Encourage smokers to stop Offer drug treatment with inhalers Consider referral for pulmonary rehabilitation Consider a mucolytic or theophylline Advise an annual influenza vaccination and a once-only pneumococcal vaccination Reduces hospitalization and death rates in elderly people with chronic lung disease.
12
CCG prescribing trend – volume
13
CCG prescribing trend – spend
14
COPD – comparison of cost/QALY
Stop Smoking Support with pharmacotherapy £2,000/ quality adjusted life-years (QALY) Pulmonary Rehabilitation £2,000-8,000/QALY Tiotropium £7,000/QALY LABA £5,000-8,000/QALY Triple Therapy £7,000 to £187,000/QALY
15
GP / Practice Pharmacist Work Plans
Brand prescribing of inhalers Step down therapy or step across to a cost-effective inhaler Switching inhalers for asthma and COPD - to reflect license Tiotropium/Spiriva switched to Braltus
16
Economic considerations
Device Spiriva Handihaler (device and 30 capsules) Spiriva Handihaler (refill - 30 capsules) Braltus (device and 30 capsules)
17
Any
Similar presentations
© 2025 SlidePlayer.com. Inc.
All rights reserved.