Acute Care of COPD: Gaps in our knowledge. Robert A. Wise, M.D. May 20, 2010

Size: px
Start display at page:

Download "Acute Care of COPD: Gaps in our knowledge. Robert A. Wise, M.D. May 20, 2010"

Transcription

1 Acute Care of COPD: Gaps in our knowledge Robert A. Wise, M.D. May 20, 2010

2 Outline of talk Importance of COPD exacerbations Current treatments Areas for improvement Significant knowledge gaps Strategies for improving care

3 Importance of COPD exacerbations

4 Outcome of Exacerbations Room for In outpatients Improvement Treatment failure rate 13%-33% In ER patients In hospitalized patients In ICU patients Relapse (repeat ER visit) Hospital mortality Hospital mortality 22%-32% 5%-10% 20%-24% Seneff et al. JAMA. 1995; 274: ; Murata et al. Ann Emerg Med. 1991;20: ; Adams et al. Chest. 2000;117:

5 Exacerbations Affect Quality of Life SGRQ Score * Total * * * 48 SymptomsActivities Impacts Activities 0-2 Exacerbations 3-8 Exacerbations * P<0.05 versus lower exacerbation rate Seemungal TA, et al. Am J Respir Crit Care Med. 2000;161:

6 Baseline Rate of Change in SGRQ (control group) and Exacerbation Frequency During the UPLIFT Trial Rate of change in SGRQ total score (units/yr) >0 to 1 >1 to 2 >2 Exacerbation Rate (per patient-year) SGRQ, St George s Respiratory Questionnaire

7 High Mortality Following Emergency Department Visit for COPD Exacerbation Percent Mortality 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% 5% 9% 11% 16% 23% 32% 39% 30 Days 60 Days 90 Days 180 Days 1 Year 2 Years 3 Years Time Following Visit Kim S, et al. COPD. 2006;3:

8 Effects of Repeated Exacerbations on Survival 1.0 Prospective study Cohort of 304 males Exacerbations requiring hospital treatment during the year Follow-up over 5 years Probability of surviving No exacerbation p< exacerbations p= exacerbations Soler-Cataluña JJ et al. Thorax 2005;64: Time (months)

9 2010 projected Health Care Costs for COPD Long-term Care, $3.7 Home Health Care, $1.3 Prescriptions, $5.8 Hospital Care, $13.2. Cost in Billions Total = $29.5 Physican Fees, $5.5 Hospital Care Physican Fees Prescriptions Home Health Care Long-term Care

10 Recurrence of Exacerbations 27% of first exacerbations associated with second exacerbation in 8 weeks 34% of 1,221 hospitalized patients in UK readmitted within 3 months (range 5-65%) C M Roberts et al.thorax 2002;57: Hurst et al. Am J Respir Crit Care Med 2009; 179:369

11 Effects of Repeated Exacerbations on Recovery of QoL 60 N=133 6-month prospective study SGRQ total score N=299 N=133 N=280 N=116 N=233 N=115 N=221 After one exacerbation treated with antibiotics Followed for 26 weeks. 31% had recurrent exacerbation N =Patients remaining in the study at that time point With a further exacerbation 30 Presentation 4 weeks 12 weeks 26 weeks No new exacerbation Spencer S. et al. Thorax 2003;58:589

12 Recurrent admissions after hospital discharge the critical issue for COPD in % of patients account for 70% of costs Medicare reimbursement schedule makes hospitals interested High mortality in frequent exacerbators Wide range of readmissions at hospitals (5-65%) Event rate high enough to study easily Outcome measure easy to count We can probably do something about it

13 Triple therapy Fewer hospitalizations % Pts with 1 or more exacerbation(s) Tiotropium (n=156) Tiotropium + Salmeterol (n=148) Tiotropium + Salmeterol + Fluticasone (n=145) 62.8 % 64.8% 60.0% Total Exacerbations Exacerbations with Hosp * Aaron et. al. Ann Int Med. 2007

14 Checklist for Acute Coronary Syndrome Discharge ASA ACE / ARB Beta-blocker Statin Rehabilitation / Exercise prescription Smoking cessation treatment / adjuncts Hypertension treated

15 Checklist for AE-COPD Discharge Has he got a way to get home?

16 Checklist for AE-COPD Discharge ICS / LABA LAMA Inhaler instruction with actual devices Oxygen instruction Steroid taper instruction and monitoring Rehabilitation / Exercise prescription Self-management care plan Follow-up care plan Drug affordability

17

18 Need for economic analyses?

19 Cost-Utility Analyses - TORCH Salmeterol-Fluticasone $33,865 / QALY Salmeterol alone $20,792 / QALY Fluticasone null Salmeterol-Fluticasone $52,046 / QALY Salmeterol alone $56,519 / QALY Salmeterol-Fluticasone $43,600 / QALY Salmeterol alone $197,000 / QALY Earnshaw et al. Cost-effectiveness of fluticasone propionate/salmeterol (500/50 microg) in the treatment of COPD. Respir Med Jan;103(1): Oba Y.et al. Cost-effectiveness of salmeterol, fluticasone, and combination therapy for COPD. Am J Manag Care. 2009;15: Briggs A et al. Is treatment with ICS and LABA cost-effective for COPD? Multinational economic analysis of the TORCH study. Eur Respir J. 2010;35:532-9

20 Etiology of Exacerbations of COPD Non-infectious e.g., air pollution. climate change, noncompliance,etc. Bacteria Virus Obaji A, Sethi S. Drugs and Aging. 2001;18:1-11 Bacteria and virus

21 Immunization Influenza vaccination Pneumococcal vaccination

22 Pneumococcal Vaccine Dec-March Relative Risk of Death P = Pneumococcal vaccine I = Influenza vaccine n = 177, * 0.53 * 1 * 0 I+/P- I+/P+ I-/P- I-/P+ Vaccination status Schembri S. et al. Influenza but not pneumococcal vaccination protects against all-cause mortality in patients with COPD. Thorax. 2009;64: Adjusted for age, gender, Co-morbidities

23 Pneumococcal Vaccine Apr-Nov Relative Risk of Death P = Pneumococcal vaccine I = Influenza vaccine n = 177, * I+/P- I+/P+ I-/P- I-/P+ Vaccination status Schembri S. et al. Influenza but not pneumococcal vaccination protects against all-cause mortality in patients with COPD. Thorax. 2009;64: Adjusted for age, gender, Co-morbidities

24 Key questions Is it harmful to give pneumococcal vaccine? Is it beneficial to give influenza vaccine for hospitalized COPD patients on steroids?

25 Helium-Oxygen Mixtures Improves exercise tolerance and dynamic hyperinflation in COPD Does not improve bronchodilator response as carrier for nebulizer Question: Can Heliox by inhalation or by NIPPV prevent intubation or improve outcomes compared with NIPPV alone? Rodrigo G, Pollack C, Rodrigo C, Rowe B. Heliox for treatment of exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2002;(2):CD

26 Heliox and PPV reduces work of breathing during COPD exacerbations Jaber S, et al. Noninvasive ventilation with helium-oxygen in acute exacerbations of chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2000;161:

27 Heliox and PPV decrease PaCO2 during COPD exacerbations Jaber S, et al. Noninvasive ventilation with helium-oxygen in acute exacerbations of chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2000;161:

28 Self Management / Case Management Can t hurt, can it?

29 Self Management Cochrane Systematic Review because of heterogeneity in interventions, study populations, follow-up time, and outcome measures, data are still insufficient to formulate clear recommendations regarding the form and contents of self-management education programmes in COPD. There is an evident need for more large RCTs with a long-term follow-up, before more conclusions can be drawn. Effing et al. Self-Management education for patients with COPD. Cochrane Review :CD002990

30 Care Management in COPD N = 743 pts Usual Care vs Disease Management 1.5 hr education Action plan for self treatment Monthly f/u calls from case manager Results: All cause hospitalizations decreased 28% Rice KL, Disease Management Program for Chronic Obstructive Pulmonary Disease: A Randomized Controlled Trial. Am J Respir Crit Care Med Jan 21. Epub.

31 Mucolytics Meta-analysis of 28 trials with 7,042 pts. 21% reduction in exacerbation rate 44% reduction in days of disability 1.93 OR of remaining exacerbation free Possibly increased benefit in patients NOT on ICS Poole P, Black PN. Mucolytic agents for chronic bronchitis or chronic obstructive pulmonary disease. Cochrane Reviews 2010, CD

32 Carbocysteine PEACE Trial Carbocysteine exac/yr Placebo 1.35 exac/yr P = No effect for 3 months No interaction with ICS, smoking status Zheng JP.. Effect of carbocisteine on acute exacerbation of chronic obstructive pulmonary disease (PEACE Study): a randomised placebo-controlled study. Lancet. 2008;371::2013-8

33 Corticosteroids for COPD exacerbation in hospital Hospital days Decreased from 9.7 to 8.5 in steroid group Niewoehner DE, et al. Effect of systemic glucocorticoids on exacerbations of chronic obstructive pulmonary disease. VA Study Group. N Engl J Med. 1999;340:1941-7

34 Oral steroids after ER visit for COPD Aaron SD, et al.. Outpatient oral prednisone after emergency treatment of chronic obstructive pulmonary disease. N Engl J Med. 2003;348:

35 Steroid Resistance in COPD Induced by oxidative / nitrosative stress on HDAC2 Reduced by theophylline, anti-oxidant treatments Can adjuvants be used to augment corticosteroid efficacy? Cosio BG, Tsaprouni L, Ito K, Jazrawi E, Adcock IM, Barnes PJ. Theophylline restores histone deacetylase activity and steroid responses in COPD macrophages. J Exp Med ;200:689-95

36 Etiology of Exacerbations of COPD Non-infectious e.g., air pollution. climate change, noncompliance,etc. Bacteria Virus Obaji A, Sethi S. Drugs and Aging. 2001;18:1-11 Bacteria and virus

37 Inhalation during swallowing in COPD 14% 12% 10% 8% 6% 4% 2% 0% O.R. = 4.4, p < O.R. = 1.23, p = 0.44 Cookie Pudding COPD Control Gross RD et al. The coordination of breathing and swallowing in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2009;179:559-65

38 Can we prevent exacerbations with aspiration precautions, swallowing training, or dietary modification?

39 Etiology of Exacerbations of COPD Non-infectious e.g., air pollution. climate change, noncompliance,etc. Bacteria Virus Obaji A, Sethi S. Drugs and Aging. 2001;18:1-11 Bacteria and virus

40 Antibiotics Zpak is a simple prescription to write because it comes in a selfexplanatory packet. --- Indiana School of Optometry

41 Erythromcycin decreases frequency, severity and time to first exacerbation N = 109 pts Erythromycin 250mg bid 36% reduction in exacerbations Seemungal TA, et al. Long-term erythromycin therapy is associated with decreased chronic obstructive pulmonary disease exacerbations. Am J Respir Crit Care Med. 2008;178:

42 Clinical trial of doxycycline in COPD flares treated with corticosteroids No difference in 30 day outcomes Improved efficacy at day 10 Daniels JM, et. al.. Antibiotics in addition to systemic corticosteroids for acute exacerbations of chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2010;181:150-7

43 Impaired macrophage clearance of bacteria in COPD reversed with sulforaphane % Inoculated CFUs Vehicle PA * Sulforaphane P1 250 P2 200 P3 P4 150 P5 100 P6 P7 50 P8 P9 0 % Inoculated CFUs Vehicle NTHI * Sulforaphane P6 P7 P8 P9 P10 P11 P12 P13 P14 Courtesy of C. Harvey, S. Biswal

44 Key Messages Recurrent hospital admissions are a major lever point for improving COPD care The future probably lies with real-world studies of combined therapies Both administrative and pharmacological strategies need to be explored conjointly

45 Thank you!

Prevention of Acute COPD exacerbations

Prevention of Acute COPD exacerbations December 3, 2015 Prevention of Acute COPD exacerbations George Pyrgos MD 1 Disclosures No funding received for this presentation I have previously conducted clinical trials with Boehringer Ingelheim. Principal

More information

PUBLIC SUMMARY DOCUMENT

PUBLIC SUMMARY DOCUMENT PUBLIC SUMMARY DOCUMENT Product: Budesonide with eformoterol fumarate dihydrate, powder for oral inhalation, fixed dose combination, 400 micrograms-12 micrograms per dose, Symbicort Turbuhaler 400/12 Sponsor:

More information

Dr GH Kaye-Eddie Helen Joseph Hospital Pulmonology

Dr GH Kaye-Eddie Helen Joseph Hospital Pulmonology Dr GH Kaye-Eddie Helen Joseph Hospital Pulmonology Introduction Definitions Impact of Exacerbations Assessment of COPD Management of COPD Management of Acute Exacerbations Prevention of Exacerbations COPD

More information

4/26/2016. Strategies for Preventing COPD Exacerbations and Readmissions. Statistics. Objectives. Julie Morgan, RRT, ACCS

4/26/2016. Strategies for Preventing COPD Exacerbations and Readmissions. Statistics. Objectives. Julie Morgan, RRT, ACCS Strategies for Preventing COPD Exacerbations and Readmissions Julie Morgan, RRT, ACCS Objectives Upon completion of the program, the learner will be able to: Identify the reasons patients experience hospital

More information

Acute Exacerbations of COPD

Acute Exacerbations of COPD Acute Exacerbations of COPD Bill Vandivier MD Director, COPD Center University of Colorado Anschutz Medical Center What is an Acute Exacerbation of COPD (AECOPD)? GOLD Guidelines 2015 Acute worsening of

More information

รศ.นพ. ว ชรา บ ญสว สด M.D., Ph.D. ภาคว ชาอาย รศาสตร คณะแพทย ศาสตร มหาว ทยาล ยขอนแก น

รศ.นพ. ว ชรา บ ญสว สด M.D., Ph.D. ภาคว ชาอาย รศาสตร คณะแพทย ศาสตร มหาว ทยาล ยขอนแก น รศ.นพ. ว ชรา บ ญสว สด M.D., Ph.D. ภาคว ชาอาย รศาสตร คณะแพทย ศาสตร มหาว ทยาล ยขอนแก น 1 COPD guideline Changing concept in COPD treatment COPD in practice 2 COPD Guidelines 3 Evidence-based Guidelines 4

More information

Update in ASTHMA and COPD: Clearing the Air What Works and What Doesn t?

Update in ASTHMA and COPD: Clearing the Air What Works and What Doesn t? Update in ASTHMA and COPD: Clearing the Air What Works and What Doesn t? Blair Brooks MD Dartmouth Hitchcock Medical Center Community Faculty Development Symposium 11/05/04 Knowing is not enough: we must

More information

Outpatient Management of COPD. Alan DeAngelo, MD, FACP, FCCP LTC, MC Eisenhower Army Medical Center 25 October 2014

Outpatient Management of COPD. Alan DeAngelo, MD, FACP, FCCP LTC, MC Eisenhower Army Medical Center 25 October 2014 Outpatient Management of COPD Alan DeAngelo, MD, FACP, FCCP LTC, MC Eisenhower Army Medical Center 25 October 2014 Disclosure No financial relationships. The following presentation does not reflect the

More information

Irish Association for Emergency Medicine (IAEM) submission to the National COPD Strategy

Irish Association for Emergency Medicine (IAEM) submission to the National COPD Strategy 31 st Irish Association for Emergency Medicine (IAEM) submission to the National COPD Strategy 1 Introduction Chronic obstructive pulmonary disease (COPD) is an important disease for patients, the health

More information

Samer El Rayess, M.D. Internal Medicine, PGY3 29 January 2016

Samer El Rayess, M.D. Internal Medicine, PGY3 29 January 2016 Samer El Rayess, M.D. Internal Medicine, PGY3 29 January 2016 Case Scenario Mr. X., a 50 year old man heavy smoker 80 pack / year known to have -COPD on spiriva at home last exacerbation 9 months ago -Hypertension

More information

Bronchodilators in COPD

Bronchodilators in COPD TSANZSRS Gold Coast 2015 Can average outcomes in COPD clinical trials guide treatment strategies? Long live the FEV1? Christine McDonald Dept of Respiratory and Sleep Medicine Austin Health Institute for

More information

Update in COPD. MeiLan Han, MD MS Associate Professor University of Michigan Division of Pulmonary and Critical Care

Update in COPD. MeiLan Han, MD MS Associate Professor University of Michigan Division of Pulmonary and Critical Care Update in COPD MeiLan Han, MD MS Associate Professor University of Michigan Division of Pulmonary and Critical Care Objectives Burden of disease: Understand the need for early recognition, prevention,

More information

PLAN OF ACTION FOR. Physician Name Signature License Date

PLAN OF ACTION FOR. Physician Name Signature License Date PLAN OF ACTION FOR Patient s copy (patient s name) I Feel Well Lignes I feel short directrices of breath: I cough up sputum daily. No Yes, colour: I cough regularly. No Yes I Feel Worse I have changes

More information

Update in ASTHMA: Clearing the Air What Works and What Doesn t? Blair Brooks MD Dartmouth Hitchcock Medical Center COOP Meeting Pre Workshop 2/04/05

Update in ASTHMA: Clearing the Air What Works and What Doesn t? Blair Brooks MD Dartmouth Hitchcock Medical Center COOP Meeting Pre Workshop 2/04/05 Update in ASTHMA: Clearing the Air What Works and What Doesn t? Blair Brooks MD Dartmouth Hitchcock Medical Center COOP Meeting Pre Workshop 2/04/05 Knowing is not enough: we must apply. Willing is not

More information

Understanding the Risks and Benefits of Stepping Down Asthma MedicaDons

Understanding the Risks and Benefits of Stepping Down Asthma MedicaDons Understanding the Risks and Benefits of Stepping Down Asthma MedicaDons 4813 Workshop: Stepping Down Asthma MedicaDons: Benefits and Risks Monday March 3, 2014 4:45 pm to 6:00 pm AAAAI 2014 John B. Hagan,

More information

MANAGEMENT OF COPD EXACERBATIONS. WISIA WEDZICHA University College London, London, UK

MANAGEMENT OF COPD EXACERBATIONS. WISIA WEDZICHA University College London, London, UK MANAGEMENT OF COPD EXACERBATIONS WISIA WEDZICHA University College London, London, UK HOSPITALISATIONS IN THE UK Walker P, Calverley PMA. Lancet 2003 MORTALITY AFTER ADMISSION WITH COPD EXACERBATION %

More information

Management of exacerbations in chronic obstructive pulmonary disease in Primary Care

Management of exacerbations in chronic obstructive pulmonary disease in Primary Care Management of exacerbations in chronic obstructive pulmonary disease in Primary Care Acute exacerbations of chronic obstructive pulmonary disease (COPD) are associated with significant morbidity and mortality.

More information

Scottish Medicines Consortium

Scottish Medicines Consortium Scottish Medicines Consortium salmeterol/fluticasone 50/500 micrograms inhaler (Seretide 500 Accuhaler ) No. (450/08) GlaxoSmithKline 11 February 2008 The Scottish Medicines Consortium has completed its

More information

RES/006/APR16/AR. Speaker : Dr. Pither Sandy Tulak SpP

RES/006/APR16/AR. Speaker : Dr. Pither Sandy Tulak SpP RES/006/APR16/AR Speaker : Dr. Pither Sandy Tulak SpP Definition of Asthma (GINA 2015) Asthma is a common and potentially serious chronic disease that imposes a substantial burden on patients, their families

More information

Effects of Self. Exacerbations using Rescue Therapy

Effects of Self. Exacerbations using Rescue Therapy Effects of Self Management of COPD Exacerbations using Rescue Therapy Amira Obeid Sandy Cherry Sarah Crotty Amanda Wixey & Dr Simon Gompertz A collaboration between NHS South Birmingham & University Hospitals

More information

Definition. Chronic Obstructive Pulmonary Disease. How common is COPD now? 21/04/2016

Definition. Chronic Obstructive Pulmonary Disease. How common is COPD now? 21/04/2016 Chronic Obstructive Pulmonary Disease Biswajit Chakrabarti, MD FRCP Consultant in Respiratory and Sleep Medicine Aintree Chest Centre University Hospital Aintree, Liverpool Definition COPD is characterised

More information

Disclosure. Meet TK. Mortality. Dr. Wheeler has nothing to disclose. 3/25/2013. Objectives: An exacerbation is. COPD Management: Exacerbation

Disclosure. Meet TK. Mortality. Dr. Wheeler has nothing to disclose. 3/25/2013. Objectives: An exacerbation is. COPD Management: Exacerbation COPD Management: Exacerbation Disclosure Dr. Wheeler has nothing to disclose. Meet TK Objectives: 1 Discuss guidelines and treatment strategies for exacerbations 2 Discuss the criteria for hospitalization

More information

Severe asthma Definition, epidemiology and risk factors. Mina Gaga Athens Chest Hospital

Severe asthma Definition, epidemiology and risk factors. Mina Gaga Athens Chest Hospital Severe asthma Definition, epidemiology and risk factors Mina Gaga Athens Chest Hospital Difficult asthma Defined as asthma, poorly controlled in terms of chronic symptoms, with episodic exacerbations,

More information

Drug: mepolizumab (Nucala) Class: Interleukin-5 Receptor Antagonist Line of Business: Non-Medicare Effective Date: February 17, 2016.

Drug: mepolizumab (Nucala) Class: Interleukin-5 Receptor Antagonist Line of Business: Non-Medicare Effective Date: February 17, 2016. This policy has been developed through review of medical literature, consideration of medical necessity, generally accepted medical practice standards, and approved by the IEHP Pharmacy and Therapeutics

More information

Nye resultater med hjemme-niv. PD Dr. med. Thomas Köhnlein Respiratory Medicine (Head of Department: Prof. Dr. Tobias Welte)

Nye resultater med hjemme-niv. PD Dr. med. Thomas Köhnlein Respiratory Medicine (Head of Department: Prof. Dr. Tobias Welte) Nye resultater med hjemme-niv PD Dr. med. Thomas Köhnlein Respiratory Medicine (Head of Department: Prof. Dr. Tobias Welte) Physiologic targets of ventilation in COPD mechanical pressure support reduces

More information

MANAGEMENT AND IMPACT OF COPD EXACERBATIONS. Wisia Wedzicha National Heart and Lung Institute, Imperial College London, UK

MANAGEMENT AND IMPACT OF COPD EXACERBATIONS. Wisia Wedzicha National Heart and Lung Institute, Imperial College London, UK MANAGEMENT AND IMPACT OF COPD EXACERBATIONS Wisia Wedzicha National Heart and Lung Institute, Imperial College London, UK Presenter Disclosures Wisia Wedzicha All disclosures prior to Jan 2015 from Jan

More information

Bryan Krajicek, MD Pulmonary Medicine i Specialists, PC Assistant Professor of Medicine Creighton University School of Medicine

Bryan Krajicek, MD Pulmonary Medicine i Specialists, PC Assistant Professor of Medicine Creighton University School of Medicine COPD Update Bryan Krajicek, MD Pulmonary Medicine i Specialists, PC Assistant Professor of Medicine Creighton University School of Medicine Disclosures Dr. Krajicek has no financial interest that would

More information

3/11/15. COPD Disease Management Tackling the Transition. Objectives. Describe the multidisciplinary approach to inpatient care for COPD patients

3/11/15. COPD Disease Management Tackling the Transition. Objectives. Describe the multidisciplinary approach to inpatient care for COPD patients Faculty Disclosures COPD Disease Management Tackling the Transition Dr. Cappelluti has no actual or potential conflicts of interest associated with this presentation. Jane Reardon has no actual or potential

More information

Diagnosis and Management of Chronic Obstructive Pulmonary Disease (COPD)

Diagnosis and Management of Chronic Obstructive Pulmonary Disease (COPD) Quality Improvement Support: Diagnosis and Management of Chronic Obstructive Pulmonary Disease (COPD) The Aims and Measures section is intended to provide protocol users with a menu of measures for multiple

More information

Management of acute exacerbations of COPD and Asthma similarities and differences

Management of acute exacerbations of COPD and Asthma similarities and differences Management of acute exacerbations of COPD and Asthma similarities and differences Importance Imp cause of morbidity and mortality Accelerated decline in lung function Poorer quality of life Increased medical

More information

New inhaled drugs for asthma & COPD: integration into UK practice

New inhaled drugs for asthma & COPD: integration into UK practice New inhaled drugs for asthma & COPD: integration into UK practice Hasanin Khachi Lead Pharmacist - Respiratory Medicine Joint Chair UKCPA Respiratory Group Barts Health NHS Trust 30 th September 2014 Outline

More information

Pathway for Diagnosing COPD

Pathway for Diagnosing COPD Pathway for Diagnosing Visit 1 Registry Clients at Risk Patient presents with symptoms suggestive of Exertional breathlessness Chronic cough Regular sputum production Frequent bronchitis ; wheeze Occupational

More information

4/12/2010 Update in the management of Asthma and COPD M. Shafick Gareeboo Consultant Chest Physician Consultant Chest 1

4/12/2010 Update in the management of Asthma and COPD M. Shafick Gareeboo Consultant Chest Physician Consultant Chest 1 Update in the management of Asthma and COPD M. Shafick Gareeboo Consultant Chest Physician 1 Content Current guidelines in asthma management Current guidelines in COPD management New treatment for COPD

More information

CARE GUIDE for COPD SUGGESTED GUIDELINES

CARE GUIDE for COPD SUGGESTED GUIDELINES CARE GUIDE for COPD SUGGESTED Screen All Current and Ex-Smokers for COPD (1-3, 4, 12) Confirm Diagnosis of COPD with Spirometry (1-3) Perform focused H & P Order a post bronchodilator spirometry (nebulizer

More information

SUMMARY OF RECOMMENDATIONS FOR CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)

SUMMARY OF RECOMMENDATIONS FOR CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) SUMMARY OF RECOMMENDATIONS FOR CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) Diagnosis and diagnostic tools Recommendation 1 Diagnosis of COPD (IV) It is recommended that spirometry should be performed

More information

Diagnosis of COPD. COPD: Preventable and Treatable. Financial Disclosures. Lecture Outline. COPD: Defining Terms

Diagnosis of COPD. COPD: Preventable and Treatable. Financial Disclosures. Lecture Outline. COPD: Defining Terms COPD: Preventable and Treatable Christopher H. Fanta, MD Partners Asthma Center Pulmonary and Critical Care Division Brigham and Women s Hospital Harvard Medical School Financial Disclosures Christopher

More information

Best Practices in Managing Patients With Chronic Obstructive Pulmonary Disease (COPD)

Best Practices in Managing Patients With Chronic Obstructive Pulmonary Disease (COPD) Best Practices in Managing Patients With Chronic Obstructive Pulmonary Disease (COPD) Harvard Vanguard Medical Associates Case Study Organization Profile Founded in the 1960s, Harvard Vanguard Medical

More information

COPD Managing the Acute Phase and Preventing Readmissions

COPD Managing the Acute Phase and Preventing Readmissions COPD Managing the Acute Phase and Preventing Readmissions Professor Bill MacNee Centre for Inflammation Research Queen s Medical Research Institute and The Royal Infirmary of Edinburgh 4 th International

More information

A. Chronic inflammation from repeated exposure to noxious particles and gases

A. Chronic inflammation from repeated exposure to noxious particles and gases CHAPTER 15. CHRONIC OBSTRUCTIVE PULMONARY DISEASE SELF-ASSESSMENT QUESTIONS 1. All of the following play a role in the pathophysiology of COPD except: A. Chronic inflammation from repeated exposure to

More information

Managing an Exacerbation of Your Chronic Obstructive Pulmonary Disease (COPD)

Managing an Exacerbation of Your Chronic Obstructive Pulmonary Disease (COPD) Managing an Exacerbation of Your Chronic Obstructive Pulmonary Disease Patient held record and self-management plan Keep this in a safe place and bring it with you to GP or hospital visits, including admissions.

More information

FA 519 : Oxygen Administration for First Aid

FA 519 : Oxygen Administration for First Aid FA 519 : Oxygen Administration for First Aid TFQO: Wei-Tien Chang COI #301 EVREV 1: Michael Nemeth COI # EVREV 2: Chih-Hung Wang COI # Taskforce: First Aid COI Disclosure (specific to this systematic review)

More information

Pulmonary rehabilitation

Pulmonary rehabilitation 29 Pulmonary rehabilitation Background i Key points There is a sound evidence base showing the effects of pulmonary rehabilitation on chronic obstructive pulmonary disease symptoms and health-related quality

More information

Outcome of Drug Counseling of Outpatients in Chronic Obstructive Pulmonary Disease Clinic at Thawangpha Hospital

Outcome of Drug Counseling of Outpatients in Chronic Obstructive Pulmonary Disease Clinic at Thawangpha Hospital Mahidol University Journal of Pharmaceutical Sciences 008; 35(14): 81. Original Article Outcome of Drug Counseling of Outpatients in Chronic Obstructive Pulmonary Disease Clinic at Thawangpha Hospital

More information

COPD and Asthma Management. Allison Nykolaychuk,, RRT, FCSRT Education Coordinator Respiratory Therapy Zone 2, Horizon Health Network

COPD and Asthma Management. Allison Nykolaychuk,, RRT, FCSRT Education Coordinator Respiratory Therapy Zone 2, Horizon Health Network COPD and Asthma Management Allison Nykolaychuk,, RRT, FCSRT Education Coordinator Respiratory Therapy Zone 2, Horizon Health Network What are we talking about? Asthma Definition: Consider when symptoms

More information

COPD. Case Study Feedback. bpac nz better medicine

COPD. Case Study Feedback. bpac nz better medicine COPD Case Study Feedback bpac nz better medicine Contents COPD Case Study... 2 Results with GP panel comments... 4 Review by Respiratory Physician - Professor Ian Town... 7 Individualised Feedback bpac

More information

J of Evolution of Med and Dent Sci/ eissn- 2278-4802, pissn- 2278-4748/ Vol. 3/ Issue 65/Nov 27, 2014 Page 13575

J of Evolution of Med and Dent Sci/ eissn- 2278-4802, pissn- 2278-4748/ Vol. 3/ Issue 65/Nov 27, 2014 Page 13575 EFFECT OF BREATHING EXERCISES ON BIOPHYSIOLOGICAL PARAMETERS AND QUALITY OF LIFE OF PATIENTS WITH COPD AT A TERTIARY CARE CENTRE Sudin Koshy 1, Rugma Pillai S 2 HOW TO CITE THIS ARTICLE: Sudin Koshy, Rugma

More information

Drugs Used in Asthma and COPD

Drugs Used in Asthma and COPD Drugs Used in Asthma and COPD Charts 1 and 2 show trends in prescribing for asthma and chronic obstructive pulmonary disease (COPD). Although the recorded prevalence of asthma is higher (5.4% of registered

More information

ESCMID Online Lecture Library. by author

ESCMID Online Lecture Library. by author Do statins improve outcomes of patients with sepsis and pneumonia? Jordi Carratalà Department of Infectious Diseases Statins for sepsis & community-acquired pneumonia Sepsis and CAP are major healthcare

More information

Predictors of Adherence to Inhaled Medications among Veterans with COPD. John Huetsch

Predictors of Adherence to Inhaled Medications among Veterans with COPD. John Huetsch Predictors of Adherence to Inhaled Medications among Veterans with COPD John Huetsch Background Medication nonadherence is a problem common to the treatment of many chronic diseases Potential obstacles

More information

Global Strategy for the Diagnosis, Management and Prevention of COPD 2016 Clinical Practice Guideline. MedStar Health

Global Strategy for the Diagnosis, Management and Prevention of COPD 2016 Clinical Practice Guideline. MedStar Health Global Strategy f the Diagnosis, Management and Prevention of COPD 2016 Clinical Practice Guideline MedStar Health These guidelines are provided to assist physicians and other clinicians in making decisions

More information

Year in Review 2013 Intensive Care. J.G. van der Hoeven Radboud University Medical Centre Nijmegen

Year in Review 2013 Intensive Care. J.G. van der Hoeven Radboud University Medical Centre Nijmegen Year in Review 2013 Intensive Care J.G. van der Hoeven Radboud University Medical Centre Nijmegen Contents ARDS Ventilator associated pneumonia Tracheostomy and endotracheal intubation General ICU care

More information

Ipratropium bromide/salbutamol

Ipratropium bromide/salbutamol Ipratropium bromide VI.2 Elements for a public summary VI.2.1 Overview of disease epidemiology Chronic obstructive pulmonary disease (COPD): Chronic obstructive pulmonary disease (COPD) is an umbrella

More information

Mieux vivre avec une BPCO: Comment implémenter auprès du patient? Autogestion et Soins Intégrés. Disclosure information. Outline.

Mieux vivre avec une BPCO: Comment implémenter auprès du patient? Autogestion et Soins Intégrés. Disclosure information. Outline. Mieux vivre avec une BPCO: Comment implémenter auprès du patient? Autogestion et Soins Intégrés Jean Bourbeau, MD Respiratory Epidemiology and Clinical Research Unit (RECRU) Montreal Chest Institute McGill

More information

Waterloo Wellington Rehabilitative Care System Integrated Care Pathway for COPD Stream of Care (short version)

Waterloo Wellington Rehabilitative Care System Integrated Care Pathway for COPD Stream of Care (short version) Waterloo Wellington Rehabilitative Care System Integrated Care Pathway for COPD Stream of Care (short version) Care Setting ACUTE Activity Confirmation of COPD diagnoses: If time and the patient s condition

More information

Reslizumab for treating asthma with elevated blood eosinophils inadequately controlled by inhaled corticosteroids [ID872]

Reslizumab for treating asthma with elevated blood eosinophils inadequately controlled by inhaled corticosteroids [ID872] For public handouts Reslizumab for treating asthma with elevated blood eosinophils inadequately controlled by inhaled corticosteroids [ID872] 1 st Appraisal Committee meeting Clinical Effectiveness and

More information

Scottish Medicines Consortium. erdosteine 300mg capsules (Erdotin ) No. (415/07) Edmond Pharma Sr.l/Galen Ltd. 5 October 2007

Scottish Medicines Consortium. erdosteine 300mg capsules (Erdotin ) No. (415/07) Edmond Pharma Sr.l/Galen Ltd. 5 October 2007 Scottish Medicines Consortium erdosteine 300mg capsules (Erdotin ) No. (415/07) Edmond Pharma Sr.l/Galen Ltd. 5 October 2007 The Scottish Medicines Consortium has completed its assessment of the above

More information

Optimising COPD Management in Primary Care - ADHB region

Optimising COPD Management in Primary Care - ADHB region Optimising COPD Management in Primary Care - ADHB region Auckland PHO 4 th November 2014 Acknowledgement of J Bycroft GP Liaison and P Birch Physio Specialist ADHB for some content of this presentation.

More information

PCOM Letterhead [Substitute same from participating institution and, of course, change Department, PI, and Co-Investigators]

PCOM Letterhead [Substitute same from participating institution and, of course, change Department, PI, and Co-Investigators] PCOM Letterhead [Substitute same from participating institution and, of course, change Department, PI, and Co-Investigators] Department of Neuroscience, Physiology and Pharmacology 215-871-6880 PATIENT

More information

Asthma and COPD. Trends in Prescribing of Drugs for Asthma and COPD in General Practice in England (Chart 1)

Asthma and COPD. Trends in Prescribing of Drugs for Asthma and COPD in General Practice in England (Chart 1) Asthma and COPD This review will focus on the most recent evidence regarding the safety of currently recommended options for treating chronic asthma and exacerbations in chronic obstructive pulmonary disease

More information

Role of dual bronchodilation in COPD

Role of dual bronchodilation in COPD Role of dual bronchodilation in COPD Canadian Respiratory Conference, Calgary, May 25 th, 2014 François Maltais Centre de Pneumologie IUCPQ Québec. Canada Disclosure Speaker bureau: Boehringer Ingelheim,

More information

Indacaterol (Onbrez)

Indacaterol (Onbrez) 1 for chronic obstructive pulmonary disease (IN-da-CAT-er-ol) A once-daily beta 2 -agonist for chronic obstructive pulmonary disease Key points Once-daily dosing provides symptomatic relief in COPD Indacaterol

More information

ONCE-DAILY TIOTROPIUM RESPIMAT ADD-ON TO ICS ± LABA IMPROVES CONTROL ACROSS ASTHMA SEVERITIES

ONCE-DAILY TIOTROPIUM RESPIMAT ADD-ON TO ICS ± LABA IMPROVES CONTROL ACROSS ASTHMA SEVERITIES SPIRIVA Respimat is approved for use in asthma in the EU, Japan, the USA and many other countries. The label varies by country. Please refer to the local product information ONCE-DAILY TIOTROPIUM RESPIMAT

More information

FREQUENT EXACERBATORS IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE: FROM RESEARCH TO CLINICAL PRACTICE

FREQUENT EXACERBATORS IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE: FROM RESEARCH TO CLINICAL PRACTICE FREQUENT EXACERBATORS IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE: FROM RESEARCH TO CLINICAL PRACTICE Richard Hewitt, 1 *Patrick Mallia 2 1. Imperial College Healthcare NHS Trust, London, UK 2. Airway Disease

More information

Cost-effectiveness of Pirfenidone (Esbriet ) for the treatment of Idiopathic Pulmonary Fibrosis.

Cost-effectiveness of Pirfenidone (Esbriet ) for the treatment of Idiopathic Pulmonary Fibrosis. Cost-effectiveness of Pirfenidone (Esbriet ) for the treatment of Idiopathic Pulmonary Fibrosis. March 2013 1. Pirfenidone is indicated in adults for the treatment of mild to moderate Idiopathic Pulmonary

More information

Pulmonary Rehabilitation in Newark and Sherwood

Pulmonary Rehabilitation in Newark and Sherwood Pulmonary Rehabilitation in Newark and Sherwood With exception of smoking cessation pulmonary rehabilitation is the single most effective intervention for any patient with COPD. A Cochrane review published

More information

Topic: New Treatment = Better Outcome?

Topic: New Treatment = Better Outcome? Session on COPD: Novel Concepts and Promising New Drugs Topic: New Treatment = Better Outcome? Through a CME Grant sponsored by New Treatment = Better Outcome? Tim S. Trinidad, MD Disclosure Present: COPD

More information

COPD Treatment From the Office to the Hospital

COPD Treatment From the Office to the Hospital COPD Treatment From the Office to the Hospital Demondes Haynes, M.D., FCCP Associate Professor of Medicine Fellowship Program Director Division of Pulmonary & Critical Care Medicine June 4, 2016 Disclosures

More information

COPD RESOURCE PACK SECTION 2. Initiating a COPD Clinic: Protocol & Assessment

COPD RESOURCE PACK SECTION 2. Initiating a COPD Clinic: Protocol & Assessment COPD RESOURCE PACK SECTION 2 Initiating a COPD Clinic: Protocol & Assessment In this section: 1. Initiating a chronic disease management clinic 2. Equipment for a COPD clinic 3. Primary care chronic obstructive

More information

Hospital to Physician Office to Home: A Respiratory Led Program Across the Continuum of Care

Hospital to Physician Office to Home: A Respiratory Led Program Across the Continuum of Care Hospital to Physician Office to Home: A Respiratory Led Program Across the Continuum of Care Charley P. Starnes, RRT, RCP Clinical Respiratory Specialist- COPD Education Important Milestones July 2011-

More information

Improvement in Dyspnea Implementing Pulmonary Rehabilitation in the Home

Improvement in Dyspnea Implementing Pulmonary Rehabilitation in the Home Improvement in Dyspnea Implementing Pulmonary Rehabilitation in the Home Mary Cesarz MS, PT Lisa Gorski MS, APRN, BC, FAAN Wheaton Franciscan Home Health & Hospice Milwaukee, WI Objectives To identify

More information

Value of Homecare: COPD and Long-Term Oxygen Therapy. A White Paper

Value of Homecare: COPD and Long-Term Oxygen Therapy. A White Paper Value of Homecare: COPD and Long-Term Oxygen Therapy A White Paper Chronic Obstructive Pulmonary Disease (COPD) is the 4 th leading cause of death in the world and afflicts over 14 million Americans. The

More information

COPD and Asthma Differential Diagnosis

COPD and Asthma Differential Diagnosis COPD and Asthma Differential Diagnosis Chronic Obstructive Pulmonary Disease (COPD) is the third leading cause of death in America. Learning Objectives Use tools to effectively diagnose chronic obstructive

More information

Hospital-at-Home Programs for Patients With Acute Exacerbations of Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis

Hospital-at-Home Programs for Patients With Acute Exacerbations of Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Hospital-at-Home Programs for Patients With Acute Exacerbations of Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis BR McCurdy March 2012 Ontario Health Technology Assessment Series;

More information

Chronic Obstructive Pulmonary Disease (COPD) Exacerbation. Protocol in Primary Care for South Kent CCG

Chronic Obstructive Pulmonary Disease (COPD) Exacerbation. Protocol in Primary Care for South Kent CCG Chronic Obstructive Pulmonary Disease (COPD) Exacerbation Protocol in Primary Care for South Kent CCG NHS South Kent Coast CCG, Council Offices, White Cliffs Business Park, Dover CT16 3PJ T.030004 24700

More information

Prolonged Mechanical Ventilator Weaning: Experience from Ontario

Prolonged Mechanical Ventilator Weaning: Experience from Ontario Prolonged Mechanical Ventilator Weaning: Experience from Ontario Louise Rose Lawrence S. Bloomberg Professor in Critical Care Nursing, University of Toronto Director of Research, Provincial Centre of Weaning

More information

Mepolizumab (Nucala ) for Treatment of Severe Asthma with Eosinophilic Inflammation: Effectiveness, Value, and Value-Based Price Benchmarks

Mepolizumab (Nucala ) for Treatment of Severe Asthma with Eosinophilic Inflammation: Effectiveness, Value, and Value-Based Price Benchmarks Mepolizumab (Nucala ) for Treatment of Severe Asthma with Eosinophilic Inflammation: Effectiveness, Value, and Value-Based Price Benchmarks Final Background and Scope November 18, 2015 Background: The

More information

Clinical Practice Guideline for the Management of Asthma in Children and Adults

Clinical Practice Guideline for the Management of Asthma in Children and Adults Clinical Practice Guideline for the Management of Asthma in Children and Adults Assessment: A critical aspect of the diagnosis and management of asthma is the precise and periodic measurement of lung function

More information

This clinical study synopsis is provided in line with Boehringer Ingelheim s Policy on Transparency and Publication of Clinical Study Data.

This clinical study synopsis is provided in line with Boehringer Ingelheim s Policy on Transparency and Publication of Clinical Study Data. abcd Clinical Study for Public Disclosure This clinical study synopsis is provided in line with s Policy on Transparency and Publication of Clinical Study Data. The synopsis which is part of the clinical

More information

Exploring the Chronic Obstructive Pulmonary Disease (COPD) Clinical Pathway. Health Quality Ontario s integrated episode of care for COPD

Exploring the Chronic Obstructive Pulmonary Disease (COPD) Clinical Pathway. Health Quality Ontario s integrated episode of care for COPD Exploring the Chronic Obstructive Pulmonary Disease (COPD) Clinical Pathway Health Quality Ontario s integrated episode of care for COPD Dr. Charlie Chan Health Quality Ontario Expert Panel Co-Chair May/June

More information

COPD - Education for Patients and Carers Integrated Care Pathway

COPD - Education for Patients and Carers Integrated Care Pathway Patient NHS COPD - Education for Patients and Carers Integrated Care Pathway Date ICP completed:. Is the patient following another Integrated Care Pathway[s].. / If yes, record which other Integrated Care

More information

Chronic Obstructive Pulmonary Disease

Chronic Obstructive Pulmonary Disease Chronic Obstructive Pulmonary Disease Catherine Casey S. Jones, PhD, RN, ANP-C, AE-C Certified Adult Nurse Practitioner Texas Pulmonary & Critical Care Consultants P.A. and Adjunct Professor at Texas Woman

More information

Nonin Medical COPD STEP Readmission Reduction Plan. A Patient-Centered Disease Management Plan to Improving COPD Outcomes

Nonin Medical COPD STEP Readmission Reduction Plan. A Patient-Centered Disease Management Plan to Improving COPD Outcomes Nonin Medical COPD STEP Readmission Reduction Plan A Patient-Centered Disease Management Plan to Improving COPD Outcomes THE PROBLEM: Most hospitals have programs in place to treat the acute aspects of

More information

MANAGEMENT OF LIPID DISORDERS: IMPLICATIONS OF THE NEW GUIDELINES

MANAGEMENT OF LIPID DISORDERS: IMPLICATIONS OF THE NEW GUIDELINES MANAGEMENT OF LIPID DISORDERS: IMPLICATIONS OF THE NEW GUIDELINES Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine Declaration of full disclosure: No conflict of interest EXPLAINING

More information

Co-morbiditeit associeert met respiratoire aandoeningen louter omwille van de leeftijd. COPD patiënten hebben veel meer kans op longkanker dan rokers

Co-morbiditeit associeert met respiratoire aandoeningen louter omwille van de leeftijd. COPD patiënten hebben veel meer kans op longkanker dan rokers Academisch centrum huisartsgeneeskunde Pneumologie Juni 2012 Prof W Janssens Co-morbiditeit associeert met respiratoire aandoeningen louter omwille van de leeftijd. COPD patiënten hebben veel meer kans

More information

Update in Asthma and COPD: the Hospitalized Patient. Prescott Woodruff, MD, MPH Associate Professor of Medicine, UCSF

Update in Asthma and COPD: the Hospitalized Patient. Prescott Woodruff, MD, MPH Associate Professor of Medicine, UCSF Update in Asthma and COPD: the Hospitalized Patient Prescott Woodruff, MD, MPH Associate Professor of Medicine, UCSF Disclosures Genentech: research grant (completed) Merck: consultant Boehringer-Ingelheim:

More information

Pulmonary Rehabilitation in Chronic Obstructive Pulmonary Disease (COPD)

Pulmonary Rehabilitation in Chronic Obstructive Pulmonary Disease (COPD) Pulmonary Rehabilitation in Chronic Obstructive Pulmonary Disease (COPD) Development of disability in COPD The decline in airway function may initially go unnoticed as people adapt their lives to avoid

More information

Acute Exacerbations of COPD- Is the hospital necessary? Umur Hatipoğlu,MD Director, COPD Center Respiratory Institute, Cleveland Clinic October 2016

Acute Exacerbations of COPD- Is the hospital necessary? Umur Hatipoğlu,MD Director, COPD Center Respiratory Institute, Cleveland Clinic October 2016 Acute Exacerbations of COPD- Is the hospital necessary? Umur Hatipoğlu,MD Director, COPD Center Respiratory Institute, Cleveland Clinic October 2016 Burden of COPD 10.3 million individuals with COPD 149,205

More information

Improving the Quality of Post Discharge Contacts

Improving the Quality of Post Discharge Contacts Improving the Quality of Post Discharge Contacts R. Neal Axon, MD, MSCR PART Lead Physician January, 2014 Planning Phase 1 Phase 2 Phase 3 Maintenance (0-3 months) (4-9 months) (10-15 months) (16-18 months)

More information

ASTHMA CLINICAL PRACTICE GUIDELINES

ASTHMA CLINICAL PRACTICE GUIDELINES ASTHMA CLINICAL PRACTICE GUIDELINES INITIAL CARE Assess ABCs Airway Breathing Circulation Initial Triage Options Emergency Department or Outpatient Management Admission to Inpatient Unit Stabilize and

More information

Achieving Quality and Value in Chronic Care Management

Achieving Quality and Value in Chronic Care Management The Burden of Chronic Disease One of the greatest burdens on the US healthcare system is the rapidly growing rate of chronic disease. These statistics illustrate the scope of the problem: Nearly half of

More information

VENTILATOR ASSOCIATED PNEUMONIA (VAP)

VENTILATOR ASSOCIATED PNEUMONIA (VAP) VENTILATOR ASSOCIATED PNEUMONIA (VAP) outline Definitions and epidemiology Risk factors Diagnosis Treatment background HAP is the second most common nosocomial infection Incidence 5 10 cases per 1000

More information

CLINICAL PATHWAY. Acute Medicine. Chronic Obstructive Pulmonary Disease

CLINICAL PATHWAY. Acute Medicine. Chronic Obstructive Pulmonary Disease CLINICAL PATHWAY Acute Medicine Chronic Obstructive Pulmonary Disease Chronic Obstructive Pulmonary Disease Table of Contents (tap to jump to page) INTRODUCTION 1 Scope of this Pathway 1 Pathway Contacts

More information

Apixaban Plus Mono vs. Dual Antiplatelet Therapy in Acute Coronary Syndromes: Insights from the APPRAISE-2 Trial

Apixaban Plus Mono vs. Dual Antiplatelet Therapy in Acute Coronary Syndromes: Insights from the APPRAISE-2 Trial Apixaban Plus Mono vs. Dual Antiplatelet Therapy in Acute Coronary Syndromes: Insights from the APPRAISE-2 Trial Connie N. Hess, MD, MHS, Stefan James, MD, PhD, Renato D. Lopes, MD, PhD, Daniel M. Wojdyla,

More information

Role of Bi-Pap in Acute Respiratory Failure due to Acute Exacerbation of COPD

Role of Bi-Pap in Acute Respiratory Failure due to Acute Exacerbation of COPD Role of Bi-Pap in Acute Respiratory Failure due to Acute Exacerbation of COPD N. Rizvi,N. Mehmood,N. Hussain ( Department of Chest Medicine, Jinnah Postgraduate Medical Centre, Karachi. ) Abstract Objective:

More information

Derek Linderman, MD. Pulmonary Sciences & Critical Care Medicine University of Colorado Denver Anschutz Medical Campus Aurora, CO

Derek Linderman, MD. Pulmonary Sciences & Critical Care Medicine University of Colorado Denver Anschutz Medical Campus Aurora, CO Derek Linderman, MD Pulmonary Sciences & Critical Care Medicine University of Colorado Denver Anschutz Medical Campus Aurora, CO COPD-related mortality in the Rocky Mountain West, including Colorado, is

More information

Wandsworth Respiratory Clinical Reference Group Annual Progress Report 2014/15

Wandsworth Respiratory Clinical Reference Group Annual Progress Report 2014/15 Wandsworth Respiratory Clinical Reference Group Annual Progress Report 2014/15 April 2015 Dr Kieron Earney & Kate Symons Acknowledgements Dr Sarah Deedat Public Health Lead for Long Term Conditions 1 1.

More information

ECMO for ARDS Unproven, Expensive, Dangerous! Sagar Damle, MD Grand Rounds September 27, 2010

ECMO for ARDS Unproven, Expensive, Dangerous! Sagar Damle, MD Grand Rounds September 27, 2010 ECMO for ARDS Unproven, Expensive, Dangerous! Sagar Damle, MD Grand Rounds September 27, 2010 ALI/ARDS Definition (A/E Consensus conference) Acute Onset Bilateral infiltrate R/O cardiogenic (PCWP

More information

Chronic Obstructive Pulmonary Disease (COPD) Admission Order Set

Chronic Obstructive Pulmonary Disease (COPD) Admission Order Set Patient Name: PHN: Page 1/1 Admit to Dr: Notified Consult: Dr: Family Dr: Precautions: Contact Droplet Enhanced Droplet Airborne - Reason: _ Code Status: Full Resuscitation or Consults: Reason: Dietician

More information

Pharmacology of the Respiratory Tract: COPD and Steroids

Pharmacology of the Respiratory Tract: COPD and Steroids Pharmacology of the Respiratory Tract: COPD and Steroids Dr. Tillie-Louise Hackett Department of Anesthesiology, Pharmacology and Therapeutics University of British Columbia Associate Head, Centre of Heart

More information

Home Telehealth for Patients With Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis

Home Telehealth for Patients With Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Home Telehealth for Patients With Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis J Franek March 2012 Ontario Health Technology Assessment Series; Vol. 12: No. 11, pp. 1 58, March

More information