COPD Prescribing Guidelines
|
|
- Austin York
- 7 years ago
- Views:
Transcription
1 South Staffordshire Area Prescribing Group COPD Prescribing Guidelines Inhaler choices in this guideline are different from previous versions produced by the APG. It is not expected patients controlled on established therapy will be changed without clinical assessment. All NEW patients should be initiated on inhaler therapy as per these guidelines. Written by MMSESSP Review December 2016
2 COPD Prescribing Guidelines This guideline is intended for use to aid diagnosis in patients with a suspected diagnosis of a COPD, and in patients with a confirmed diagnosis of COPD. In the latter group it is intended to direct management including prescribing. It is aimed primarily at cost-effective prescribing, and will be reviewed annually as evidence is rapidly emerging in this field COPD is characterised by airflow obstruction. The airflow obstruction is usually progressive, not fully reversible and does not change markedly over several months. The disease is predominately caused by smoking. Diagnosis 1. Suspect COPD if: Any of the following indicators are present in an individual over 35 years old. Dyspnoea that is - Progressive - Characteristically worse with exercise - Persistent. Wheezing Chronic cough may be intermittent, and/or unproductive Chronic sputum production any pattern of chronic sputum production may indicate COPD History of exposure to risk factors tobacco smoke/ smoke from cooking and heating fuels/ occupational dusts and chemicals AND do not have clinical features of Asthma: Chronic unproductive cough Significantly variable breathlessness Night-time wakening with breathlessness and/or wheeze Significant diurnal or day-to-day variability of symptoms 2. Spirometry Test: Spirometry is required to establish a diagnosis of COPD. Post bronchodilator spirometry demonstrates: FEV 1 /FVC <70% NB. The presence of multiple key indicators increases the probability of diagnosis of COPD. Quality assessment 3 blows with FEV 1 values within 100ml of one another FVC obtained after blowing out 6 seconds Is it airflow obstruction? FEV 1 / FVC < Interpreting Spirometry Severity assessment Make sure it isn t asthma* FEV 1 > 80% Mild A Check reversibility to salbutamol 50-80% Moderate B >400ml = asthma 30-50% Severe C Check PEFR variation over 2/52 < 30% Very Severe D >20% = asthma
3 COPD Prescribing Guidelines Possible Alternative Diagnosis Asthma Congestive Heart Failure Bronchiectasis Tuberculosis Obliterative Bronchiolitis Diffuse Panbronchiolitis Lung Cancer (Chest X Ray- If 3 week history of cough and /or increasing breathlessness) Full blood count to identify anaemia or polycythaemia Check inhaler technique Encourage all patients to stop smoking, beneficial at all ages. Offer annual pneumococcal and influenza vaccinations. Management of Stable COPD Refer to pulmonary rehabilitation when mmrc score is 2 (or for GOLD classification B-D as per GOLD guidelines) Promote use of self-management plan and rescue packs. Template self-management plan can be found at: [Link for Self-Management Plan] Screen for common comorbidities e.g. IHD, HF, anxiety, and depression. Consider referral to the rest of the multidisciplinary team e.g. Community respiratory team / Consultant led respiratory clinic, physiotherapists, dietician (follow current malnutrition guidelines if BMI/MUST score is low or high respectively), occupational therapy, social services, and palliative care teams. Where medication is initiated for persistent breathlessness monitor and discontinue if no improvement Refer for oxygen assessment when O2 saturations are less than or equal to 92% breathing air.
4 Assessment of COPD using GOLD Classification COPD Prescribing Guidelines STEP 1: Assess symptoms COPD Assessment Test (CAT) [Link for CAT-test Online] is a patient-completed instrument that is a comprehensive measure of symptoms and complements existing approaches to assessing COPD. Determine whether patient has less symptoms (<10) or more symptoms (>10) if using CAT scale. Assess mmrc (modified Medical Research Council Questionnaire) providing an assessment of impact of dyspnoea. Determine if the patient is less breathlessness (0-1) or more breathlessness ( 2). STEP 2: Assess risk of exacerbations by the following method: Assess the number of exacerbations the patient has had within the previous 12 months Determine whether the patient has had one or more hospitalisation in the previous year for a COPD exacerbation Use spirometry to determine if patient is high risk (FEV 1 <50%) or low risk (FEV 1 50%) In some patients these three ways of assessing the risk of exacerbations will not lead to the same level of risk; in this case, the risk should be determined by the method indicating high risk Determine Gold Classification and treatment according to Table 1 GOLD Classification attempt to class patients based on their risks of exacerbation.
5 COPD Prescribing Guidelines Table 1: Gold Classification & Respective Drug Treatment Patients can start in any classification and can migrate between groups, therefore regular assessment is essential (See Appendix 2 for in list of inhaler brands, dosing, costs & images) CAT <10 STEP 1: Symptom Assessment CAT 10 Number of Exacerbations in previous 12 months Hospitalisation in previous 12 months FEV 1 mmrc 0-1 Low risk Gold A mmrc 2 Moderate risk Gold B STEP 2: Risk Assessment 1 2 zero 1 50% Predicted < 50% Predicted Step 1: SABA or SAMA (NB SABA can continue as reliever through all steps) Step 2: LABA Severe risk Gold C Step 1: ICS/LABA (if LAMA tried) Or Step 1: LAMA (if LAMA naïve) Step 2: LABA/ LAMA combination Step 1: LABA (if LABA naïve) Or Step 1: LAMA Step 2: LABA/ LAMA combination suitable where severe breathlessness Very Severe risk Gold D Triple therapy if patient has progressed from C or B. OR LABA/LAMA combination if treatment naïve Or ICS/LABA & Theophylline Or LAMA & Theophylline Inhaler choices for management of Stable patients try to maintain device consistency if possible LABA LAMA LABA/LAMA LABA/ICS Easyhaler Formoterol Seebri Breezhaler Anoro Ellipta Fostair MDI Onbrez Breezhaler 1 Incruse Ellipta Duaklir Genuair * DuoResp Spiromax Eklira Genuair* Ultibro Breezehaler Relvar Ellipta Key: 1. Starting dose 150mcg, increased to 300mcg if needed. * Twice daily preparation therefore not suitable for all patients LAMA caution use in patients with cardiac arrhythmias, recent hospitalisation with cardiac background e.g. MI, HF, etc. These are class effects
6 Managing COPD Exacerbations COPD Prescribing Guidelines Considerations: (circle as appropriate) Favours specialist treatment Favours treatment at home Able to cope at home: No Yes Breathlessness: Severe Mild General condition: Poor / deteriorating Good Level of activity: Poor / confined to bed Good Cyanosis: Yes No Worsening Peripheral Oedema: Yes No Level of consciousness: Impaired Normal LTOT currently received: Yes No Social circumstances: Living alone / not coping Good Acute confusion: Yes No Rapid rate of onset: Yes No Significant morbidity: Yes No SaO 2 <90%: Yes No Decide where to treat: Hospital Home
7 COPD Prescribing Guidelines ACUTE MANAGEMENT (at home) Steroids - Prednisolone 30mg daily for 7-14 days then stop 1st line antibiotic - Amoxicillin 500mg three times a day for 5 days; OR [Penicillin allergy] - Clarithromycin 500mg twice daily for 5 days [Significant drug Interaction] - Theophylline halve dose and - Simvastatin stop/reduce dose - Consider other interactions 2nd line antibiotic If resistant - Doxycycline 200mg immediately then 100mg daily for a further 4 days - Co-Amoxiclav 625mg three times a day for 5 days (consider C.Diff risk) Optimise treatment - Increase SABA to 2-8 puffs up to 4 hourly (watch for side effects e.g. tremor) If no improvement at one week or deterioration in symptoms, clinician to consider referral or advice from community COPD consultant / team. PREVENTION OF FUTURE EXACERBATIONS Refer to pulmonary rehabilitation Optimise inhaled therapy in line with GOLD standards above Carbocisteine - Two or more exacerbations in the next 12 month, consider adding in Carbocisteine 750mg twice daily (maintenance dose) especially if chronic productive cough - Review on-going need/ benefit and stop if ineffective after 4 6 weeks of treatment
8 COPD Prescribing Guidelines References: 1. From the Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) Available from: accessed on 8 th April NICE 2010 COPD guidelines 3. IMPRESS Guide to the relative value of COPD interventions July all drug files accessed 5. British National Formulary, version 68, BMA Mims Online accessed May 2015 ACKNOWLEDGEMENTS TO ALICE TURNER AND PAN BIRMINGHAM APC
9 Appendices COPD Prescribing Guidelines Appendix 1 - mmrc Modified Research Council Questionnaire Grade Description of Breathlessness 0 I only get breathless with strenuous exercise. 1 I get short of breath when hurrying on level ground or walking up a slight hill. 2 On level ground, I walk slower than people of the same age because of breathlessness, or have to stop for breath when walking at my own pace. 3 I stop for breath after walking about 100 yards or after a few minutes on level ground. 4 I am too breathless to leave the house or I am breathless when dressing CAT Test Online - or Direct link to CAT-test online: [Link]
10 Appendix 2 Inhaler Profile COPD Prescribing Guidelines Prescribe all inhalers by Brand Name Drug Strength Brand Picture Type of Device Separate Spacer Dose & Frequency Cost ** Salamol MDI Aerochamber Plus/Volumatic Spacer 1.46 Ventolin MDI Aerochamber Plus/Volumatic Spacer 1.50 SABA (Short Acting Beta2 Agonist) Salbutamol 100 mcg Airomir MDI Aerochamber Plus Airomir Autohaler DPI - 2 puffs when required Salamol Easi- Breathe MDI Salbutamol Easyhaler DPI Terbutaline 500 mcg Bricanyl Turbohaler DPI - 1 puff, up to four times a day 6.92 (100 doses) SAMA (Short Acting Anti- Muscarinic) Ipratropium 20 mcg Atrovent MDI Aerochamber Plus 1 puff, up to four times a day 5.56 LABA (Long Acting Beta2 Agonist) Formoterol 12 mcg Easyhaler Formoterol DPI - 1 puff Twice daily Device will last two months (120 doses)
11 COPD Prescribing Guidelines Indacaterol 150 mcg Onbrez Breezhaler & Caps DPI - 1 puff Once daily (30 doses) LAMA (Long Acting Anti- Muscarinic) Glycopyrronium 50 mcg Seebri Breezhaler & Caps DPI - 1 puff Once daily Umeclidinium 55 mcg Incruse Ellipta DPI - 1 puff Once daily (30 doses) (30 doses) Aclidinium 322 mcg Eklira Genuair DPI - 1 puff Twice daily (60 doses) LABA/ LAMA combination (Long Acting Antimuscarinic & Long Acting Beta2 Agonist) Vilanterol/ Umeclidinium Indacaterol/ Glycopyrronium Formoterol/ Aclidinium 22 mcg / 55 mcg 110 mcg / 50 mcg 12 mcg / 340 mcg Anoro Ellipta DPI - 1 puff Once daily Ultibro Breezhaler & Caps Duaklir Genuair DPI - DPI - 1 puff Once daily 1 puff Twice daily (30 doses) (30 doses) (60 doses) LABA/ICS combination (Long Acting Beta2 Agonist & Inhaled Corticosteroid) Formoterol/ Beclometasone Formoterol/ Budesonide Vilanterol/ Fluticasone 6 mcg / 100 mcg 9 mcg / 320 mcg 22 mcg / 92 mcg Fostair* MDI Aerochamber Plus DuoResp Spiromax DPI - Relvar Ellipta DPI - 2 puffs Twice daily 1 puff Twice daily 1 puff Once daily (120 doses) (60 doses) (30 doses) Note: - DPI = Dry-powder Inhaler - *Fostair NEXThaler for asthma only - MDI = Metered Dose Inhaler - Cost per device - Spacers - wash weekly, do NOT wipe dry. Replace every six to 12 months. - ** prices taken from Mims online accessed May 2015
12 Appendix 3: COPD intervention Value Pyramid COPD Prescribing Guidelines
Before prescribing for COPD management, the patient should have had appropriate assessment, including spirometry, as per NICE guidelines.
Formulary Guidance for Management of COPD patients Before prescribing for COPD management, the patient should have had appropriate assessment, including spirometry, as per NICE guidelines. For inhaler
More informationManagement 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 informationGuidance to support the stepwise review of combination inhaled corticosteroid therapy for adults ( 18yrs) in asthma
Guidance to support the stepwise review of combination inhaled corticosteroid therapy for adults ( 18yrs) in asthma Important Complete asthma control needs to be achieved for at least 12 weeks before attempting
More informationChronic obstructive pulmonary disease (COPD)
Chronic obstructive pulmonary disease (COPD) Chronic obstructive pulmonary disease (COPD) is the name for a group of lung diseases including chronic bronchitis, emphysema and chronic obstructive airways
More informationPathway 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 informationCOPD RESOURCE PACK SECTION 11. Fife Integrated COPD Care Pathways
COPD RESOURCE PCK SECTION 11 Fife Integrated COPD Care Pathways In this section: 1. COPD Guidance treatment at each stage of the disease 2. Overview of Respiratory (COPD) Integrated Pathway 3. Chronic
More informationMedication and Devices for Chronic Obstructive Pulmonary Disease (COPD)
Medication and Devices for Chronic Obstructive Pulmonary Disease (COPD) Patients with COPD take a wide variety of medicines to manage their symptoms these include: Inhaled Short Acting Bronchodilators
More informationPulmonary 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 informationRES/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 informationPrevention 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 informationOn completion of this chapter you should be able to: discuss the stepwise approach to the pharmacological management of asthma in children
7 Asthma Asthma is a common disease in children and its incidence has been increasing in recent years. Between 10-15% of children have been diagnosed with asthma. It is therefore a condition that pharmacists
More informationNICE Pathways bring together all NICE guidance, quality standards and other NICE information on a specific topic.
bring together all NICE guidance, quality standards and other NICE information on a specific topic. are interactive and designed to be used online. They are updated regularly as new NICE guidance is published.
More informationCOPD 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 informationDoncaster & Bassetlaw Medicines Formulary
Doncaster & Bassetlaw Medicines Formulary Section 3.2: Corticosteroids Beclometasone 50, 100 and 250micrograms/dose Clickhaler Clenil Modulite (Beclometasone CFC free) 50, 100, and 250micrograms/dose MDI
More informationClassifying Asthma Severity and Initiating Treatment in Children 0 4 Years of Age
Classifying Asthma Severity and Initiating Treatment in Children 0 4 Years of Age Components of Severity Symptoms Intermittent 2 days/week Classification of Asthma Severity (0 4 years of age) Persistent
More informationCOPD PROTOCOL CELLO. Leiden
COPD PROTOCOL CELLO Leiden May 2011 1 Introduction This protocol includes an explanation of the clinical picture, diagnosis, objectives and medication of COPD. The Cello way of working can be viewed on
More informationLothian Guideline for Domiciliary Oxygen Therapy Service for COPD
Lothian Guideline for Domiciliary Oxygen Therapy Service for COPD This document describes the standard for clinical assessment, prescription, optimal management and follow-up of patients receiving domiciliary
More informationClinical guideline Published: 23 June 2010 nice.org.uk/guidance/cg101
Chronic obstructive pulmonary disease in over 16s: diagnosis and management Clinical guideline Published: 23 June 2010 nice.org.uk/guidance/cg101 NICE 2010. All rights reserved. Your responsibility The
More informationPLAN 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 informationCOPD MANAGEMENT PROTOCOL STANFORD COORDINATED CARE
I. PURPOSE To establish guidelines f the collabative management of patients with a diagnosis of chronic obstructive pulmonary disease (COPD) who are not adequately controlled and to define the roles and
More informationGEORGIA MEDICAID FEE-FOR-SERVICE ASTHMA and COPD AGENTS PA SUMMARY
GEORGIA MEDICAID FEE-FOR-SERVICE ASTHMA and COPD AGENTS PA SUMMARY Preferred Anticholinergics and Combinations Atrovent HFA (ipratropium) Combivent Respimat (ipratropium/albuterol) Ipratropium neb inhalation
More informationKortverk. betaagonist. Grönmarkerat är rekommenderat i första hand vid KOL resp astma för vuxna och barn >7år. Antikolinergika.
Aerobec och Autohaler spray 50 och 100 µg/dos Anoro Ellipta 55/22 µg/dos Airflusal Forspiro 50/250 och 50/500 µg/dos Vilanterol Umeklidinium Airomir 0,1mg/dos Autohaler spray 0,1mg/dos Airsalb 0,1mg/ dos
More informationBronchodilators 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 informationMedicines Use Review Supporting Information for Asthma Patients
Medicines Use Review Supporting Information for Asthma Patients What is asthma? Asthma is a chronic inflammatory disorder of the airways. The inflammation causes an associated increase in airway hyper-responsiveness,
More informationCLINICAL 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 informationBetter Breathing with COPD
Better Breathing with COPD People with Chronic Obstructive Pulmonary Disease (COPD) often benefit from learning different breathing techniques. Pursed Lip Breathing Pursed Lip Breathing (PLB) can be very
More informationMedications for Managing COPD in Hospice Patients. Jim Joyner, PharmD, CGP Director of Clinical Operations Outcome Resources
Medications for Managing COPD in Hospice Patients Jim Joyner, PharmD, CGP Director of Clinical Operations Outcome Resources Goal of medications in COPD Decrease symptoms and/or complications Reduce frequency
More informationAsthma Intervention. An Independent Licensee of the Blue Cross and Blue Shield Association.
Asthma Intervention 1. Primary disease education Member will have an increased understanding of asthma and the classification by severity, the risks and the complications. Define asthma Explain how lungs
More informationMarilyn Borkgren-Okonek, APN, CCNS, RN, MS Suburban Lung Associates, S.C. Elk Grove Village, IL
Marilyn Borkgren-Okonek, APN, CCNS, RN, MS Suburban Lung Associates, S.C. Elk Grove Village, IL www.goldcopd.com GLOBAL INITIATIVE FOR CHRONIC OBSTRUCTIVE LUNG DISEASE GLOBAL STRATEGY FOR DIAGNOSIS, MANAGEMENT
More informationCCHCS Care Guide: Asthma
GOALS SHORTNESS OF BREATH, WHEEZE, COUGH NIGHT TIME AWAKENINGS ACTIVITY INTERFERENCE SABA* USE FOR SYMPTOM CONTROL FEV1* OR PEAK FLOW EXACERBATIONS REQUIRING ORAL STEROIDS < 2 DAYS / WEEK 2 TIMES / MONTH
More informationmedicineupdate to find out more about this medicine
medicineupdate Asking the right questions about new medicines Seretide for chronic obstructive pulmonary disease What this medicine is 1 What this medicine treats 2 Other medicines available for this condition
More informationExploratory data: COPD and blood eosinophils. David Price: 9.23-9.35am
Exploratory data: COPD and blood eosinophils David Price: 9.23-9.35am Blood Eosinophilia in COPD The reliability and utility of blood eosinophils as a marker of disease burden, healthcare resource utilisation
More informationExploring 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 informationCOPD - 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 informationChronic obstructive pulmonary disease: Management of adults with chronic obstructive pulmonary disease in primary and secondary care
Chronic obstructive pulmonary disease: Management of adults with chronic obstructive pulmonary disease in primary and secondary care NICE guideline First draft for consultation, September 2003 If you wish
More informationUnderstanding COPD. Carolinas Healthcare System
Understanding COPD Carolinas Healthcare System 2013 This self-directed learning module contains information about the pathophysiology, diagnosis, and treatment of COPD. Target Audience: All RNs and LPNs
More informationNational Learning Objectives for COPD Educators
National Learning Objectives for COPD Educators National Learning Objectives for COPD Educators The COPD Educator will be able to achieve the following objectives. Performance objectives, denoted by the
More informationAn Overview of Asthma - Diagnosis and Treatment
An Overview of Asthma - Diagnosis and Treatment Asthma is a common chronic disorder of the airways that is complex and characterized by variable and recurring symptoms, airflow obstruction, bronchial hyperresponsiveness,
More informationThe patient s response to therapy within the first hour in the Emergency Room is one of the most reliable ways to predict need for hospitalization.
Emergency Room Asthma Management Algorithm The Emergency Room Asthma Management Algorithm is to be used for any patient seen in the Emergency Room with the diagnosis of asthma. (The initial history should
More informationunderstanding the professional guidelines
SEVERE ASTHMA understanding the professional guidelines This guide includes information on what the European Respiratory Society (ERS) and the American Thoracic Society (ATS) have said about severe asthma.
More informationJames F. Kravec, M.D., F.A.C.P
James F. Kravec, M.D., F.A.C.P Chairman, Department of Internal Medicine, St. Elizabeth Health Center Chair, General Internal Medicine, Northeast Ohio Medical University Associate Medical Director, Hospice
More informationTopic: 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 informationChronic Obstructive Pulmonary Disease
Page 1 of 10 View this article online at: patient.info/health/chronic-obstructive-pulmonary-disease-leaflet Chronic Obstructive Pulmonary Disease Chronic obstructive pulmonary disease (COPD) is an umbrella
More informationDrug therapy SHORT-ACTING BETA AGONISTS SHORT-ACTING ANTICHOLINERGICS LONG-ACTING BETA AGONISTS LONG-ACTING ANTICHOLINERGICS
Drug therapy 6 6.1 What is the role of bronchodilators in COPD? 52 SHORT-ACTING BETA AGONISTS 6.2 How do short-acting beta agonists work? 52 6.3 What are the indications for their use? 52 6.4 What is the
More information5. Treatment of Asthma in Children
Treatment of sthma in hildren 5. Treatment of sthma in hildren 5.1 Maintenance Treatment 5.1.1 rugs Inhaled Glucocorticoids. Persistent wheezing in children under the age of three can be controlled with
More informationChronic obstructive pulmonary disease
12 Chronic obstructive pulmonary disease Anna Murphy Case study and questions Day 1 Mr LT, a 68-year-old man, attended his general practitioner s (GP s) surgery for a routine check-up. He had been diagnosed
More informationHighlights for COPD Management
COPD NEW DRUGS, NEW DEVICES AND CONSIDERATIONS FOR BEST PRACTICE September 2015 INSIDE Pg 2: COPD Overview - a birds eye view Pg 3: COPD Pharmacotherapy Comparison Chart - sorting out all the medication
More informationNEWS NP S. Inside. Defining COPD. Is it COPD? National Prescribing Service Newsletter
NP S NEWS National Prescribing Service Newsletter 5 1999 ISSN 1441-7421 Aug 99 Inside Bronchodilators and corticosteroids: Their use in COPD Give it up the best advice for COPD patients: NRT can help This
More informationIdiopathic Pulmonary Fibrosis
Idiopathic Pulmonary Fibrosis What is Idiopathic Pulmonary Fibrosis? Idiopathic pulmonary fibrosis (IPF) is a condition that causes persistent and progressive scarring of the tiny air sacs (alveoli) in
More informationSpirometry Workshop for Primary Care Nurse Practitioners
Spirometry Workshop for Primary Care Nurse Practitioners Catherine Casey S. Jones PhD, RN, AE-C, ANP-C Certified Adult Nurse Practitioner Texas Pulmonary & Critical Care Consultants P.A. and Visiting Assistant
More informationSponsor Novartis Pharmaceuticals
Clinical Trial Results Database Page 1 Sponsor Novartis Pharmaceuticals Generic Drug Name Indacaterol Therapeutic Area of Trial Chronic Obstructive Pulmonary Disease (COPD) Indication studied: COPD Study
More informationIrish 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 informationPharmacology 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 informationIN-HOME QUALITY IMPROVEMENT. BEST PRACTICE: DISEASE MANAGEMENT Chronic Obstructive Pulmonary Disease NURSE TRACK
IN-HOME QUALITY IMPROVEMENT BEST PRACTICE: DISEASE MANAGEMENT Chronic Obstructive Pulmonary Disease NURSE TRACK Best Practice Intervention Packages were designed for use by any In-Home Provider Agency
More informationGlobal Initiative for Chronic Obstructive Lung Disease
Global Initiative for Chronic Obstructive Lung Disease POCKET GUIDE TO COPD DIAGNOSIS, MANAGEMENT, AND PREVENTION A Guide for Health Care Professionals REVISED 2011 Global Initiative for Chronic Obstructive
More informationChronic Obstructive Pulmonary Disease Patient Guidebook
Chronic Obstructive Pulmonary Disease Patient Guidebook The Respiratory System The respiratory system consists of the lungs and air passages. The lungs are the part of the body where gases are exchanged
More information1. NAME 2. SOCIAL SECURITY NUMBER # 4. PRESENT OCCUPATION 5. PLANT 6. ADDRESS 8. TELEPHONE NUMBER 9. INTERVIEWER
ASBESTOS INITIAL MEDICAL QUESTIONNAIRE 1. NAME 2. SOCIAL SECURITY NUMBER # 3. CLOCK NUMBER 4. PRESENT OCCUPATION 5. PLANT 6. ADDRESS 7. (Zip Code) 8. TELEPHONE NUMBER 9. INTERVIEWER 10. DATE 11. Date of
More informationThe Problem with Asthma. Ruth McArthur, Practice Nurse/Trainer
The Problem with Asthma Ruth McArthur, Practice Nurse/Trainer Getting the diagnosis right! Asthma or COPD? History taking is key Both are inflammatory conditions with different mechanisms & mediators Diagnostic
More informationWandsworth 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 informationASTHMA IN INFANTS AND YOUNG CHILDREN
ASTHMA IN INFANTS AND YOUNG CHILDREN What is Asthma? Asthma is a chronic inflammatory disease of the airways. Symptoms of asthma are variable. That means that they can be mild to severe, intermittent to
More informationCOPD. What is COPD? How many people have COPD in Canada? Who gets COPD?
What is COPD? COPD stands for Chronic Obstructive Pulmonary Disease. It is a long-term lung disease that makes it difficult for air to move into and out of the lungs. COPD is used to describe a few lung
More informationCOPD Intervention. Components:
COPD Intervention 1. Primary disease education Member will have an increased understanding of chronic obstructive pulmonary disease, the causes, risks and complications. Explain COPD Explain how COPD is
More informationChronic Obstructive Pulmonary Disease
COPD Guideline Team Team Leader Davoren A Chick, MD General Medicine Team Members Paul J Grant, MD General Medicine Meilan K Han, MD, MS Pulmonary Medicine R Van Harrison, PhD Medical Education Elisa B
More informationOSHA INITIAL ASBESTOS MEDICAL QUESTIONNAIRE
OSHA INITIAL ASBESTOS MEDICAL QUESTIONNAIRE 1. NAME 2. SOCIAL SECURITY NUMBER # 3. CLOCK NUMBER FULL TIME PART TIME 4. PRESENT OCCUPATION 5. PLANT / Department 6. ADDRESS (City, ST Zip) 8. TELEPHONE NUMBER
More informationYour Go-to COPD Guide
Your Go-to COPD Guide Learning how to live with chronic obstructive pulmonary disease (COPD) Inside, you ll learn: COPD facts COPD symptoms and triggers How to talk with your doctor Different treatment
More informationPre-Operative Services Teaching Rounds 2 Jan 2011
Pre-Operative Services Teaching Rounds 2 Jan 2011 Deborah Richman MBChB FFA(SA) Director Pre-Operative Services Department of Anesthesia Stony Brook University Medical Center, NY drichman@notes.cc.sunysb.edu
More informationThe Annual Direct Care of Asthma
The Annual Direct Care of Asthma The annual direct health care cost of asthma in the United States is approximately $11.5 billion; indirect costs (e.g. lost productivity) add another $4.6 billion for a
More informationAsthma. Micah Long, MD
Asthma Micah Long, MD Goals Define the two components of asthma. Describe the method of action and uses for: Steroids (inhaled and IV) Quick Beta Agonists (Nebs and MDIs) The "Others" Magnesium, Epi IM,
More informationUnited Lung & Sleep Clinic Asbestos Questionnaire
Date United Lung & Sleep Clinic Asbestos Questionnaire 1. Name,, Last First M.I. 2. Address 3. Home Phone: ( ) - Area Code,, City State Zip Code 4. Social Security # : - - 5. Birthdate: / / Month Day Year
More informationManagement of Asthma
Federal Bureau of Prisons Clinical Practice Guidelines May 2013 Clinical guidelines are made available to the public for informational purposes only. The Federal Bureau of Prisons (BOP) does not warrant
More informationSouthwark Clinical Commissioning Group Lambeth Clinical Commissioning Group
Getting the Vision Right: A multi-disciplinary approach to providing integrated care for respiratory patients Dr Noel Baxter, GP NHS Southwark CCG Dr Irem Patel, Integrated Consultant Respiratory Physician
More informationPost-market review of COPD medicines. Joint submission from Lung Foundation Australia (LFA) and Thoracic Society of Australia and New Zealand (TSANZ)
Post-market review of COPD medicines Joint submission from Lung Foundation Australia (LFA) and Thoracic Society of Australia and New Zealand (TSANZ) EXECUTIVE SUMMARY With the addition of new medicines
More informationSPIROMETRY FOR HEALTH CARE PROVIDERS Global Initiative for Chronic Obstructive Lung Disease (GOLD)
SPIROMETRY FOR HEALTH CARE PROVIDERS Global Initiative for Chronic Obstructive Lung Disease (GOLD) CONTENTS I. INTRODUCTION II. BACKGROUND INFORMATION A. What Is Spirometry? B. Why Perform Spirometry?
More informationProf. Florian Gantner. Vice President Respiratory Diseases Research Boehringer Ingelheim
Prof. Florian Gantner Vice President Respiratory Diseases Research Boehringer Ingelheim Research and Development in Practice: COPD Chronic Obstructive Pulmonary Disease (COPD) Facts Main cause of COPD
More informationAECOPD: Management and Prevention
AECOPD: Management and Prevention Neil MacIntyre MD Duke University Medical Center Durham NC AECOPD: Management and Prevention AECOPD: Definitions and impact Acute management of AECOPD Preventing AECOPD.
More informationAsthma Triggers. What are they and what can be done about them?
Asthma Triggers What are they and what can be done about them? This brochure has been developed for the community by Asthma Australia It provides information about: Asthma triggers What you can do about
More informationYOU VE BEEN REFERRED TO AN ASTHMA SPECIALIST...
YOU VE BEEN REFERRED TO AN ASTHMA SPECIALIST... ...HERE S WHAT TO EXPECT You have been referred to an allergist because you have or may have asthma. The health professional who referred you wants you to
More informationAsthma in Infancy, Childhood and Adolescence. Presented by Frederick Lloyd, MD Palo Alto Medical Foundation Palo Alto, California
Asthma in Infancy, Childhood and Adolescence Presented by Frederick Lloyd, MD Palo Alto Medical Foundation Palo Alto, California Major Health Problem in Childhood Afflicts 2.7 million children in the USA
More informationRehabilitation and Lung Cancer Resection. Roberto Benzo MD MS Mindful Breathing Laboratory Division of Pulmonary & CCM Mayo Clinic
Rehabilitation and Lung Cancer Resection Roberto Benzo MD MS Mindful Breathing Laboratory Division of Pulmonary & CCM Mayo Clinic Disclosure Funded by the National Cancer Institute NIH for Preoperative
More informationGCE AS/A level 1661/01A APPLIED SCIENCE UNIT 1. Pre-release Article for Examination in January 2010 JD*(A09-1661-01A)
GCE AS/A level 1661/01A APPLIED SCIENCE UNIT 1 Pre-release Article for Examination in January 2010 JD*(A09-1661-01A) 2 BLANK PAGE 3 Information for Teachers The attached article on asthma is based on some
More informationDepartment of Surgery
What is emphysema? 2004 Regents of the University of Michigan Emphysema is a chronic disease of the lungs characterized by thinning and overexpansion of the lung-like blisters (bullae) in the lung tissue.
More informationJ 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 informationCOPD. (Chronic Obstructive Pulmonary Disease) (Emphysema) (Chronic Bronchitis) Education For Our Community
COPD (Chronic Obstructive Pulmonary Disease) (Emphysema) (Chronic Bronchitis) Education For Our Community Chronic Obstructive Pulmonary Disease (COPD) Definition Chronic obstructive pulmonary disease (COPD)
More informationFIBROGENIC DUST EXPOSURE
FIBROGENIC DUST EXPOSURE (ASBESTOS & SILICA) WORKER S MEDICAL SCREENING GUIDELINE Prepared By Dr. T. D. Redekop Chief Occupational Medical Officer Workplace Safety & Health Division Manitoba Labour & Immigration
More informationMedical Policy An independent licensee of the Blue Cross Blue Shield Association
Afrezza Page 1 of 6 Medical Policy An independent licensee of the Blue Cross Blue Shield Association Title: Afrezza (human insulin) Prime Therapeutics will review Prior Authorization requests Prior Authorization
More informationGlobal Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Pulmonary Disease
Page 1 of 67 AJRCCM Articles in Press. Published on August 9, 2012 as doi:10.1164/rccm.201204-0596pp GOLD Executive Summary Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive
More informationPulmonary Rehabilitation. Steve Crogan RRT Pulmonary Rehabilitation, University of Washington Medical Center Seattle, Washington 10/13/07
Pulmonary Rehabilitation Steve Crogan RRT Pulmonary Rehabilitation, University of Washington Medical Seattle, Washington 10/13/07 Pulmonary Rehabilitation Created in the 1970 s Initially intended for COPD
More informationPULMONARY FUNCTION TESTS A Workshop on Simple Spirometry & Flow Volume Loops
PULMONARY FUNCTION TESTS A Workshop on Simple Spirometry & Flow Volume Loops YOU SHOULD READ THE FOLLOWING MATERIAL BEFORE Tuesday March 30 Interpretation of PFTs Learning Objectives 1. Specify the indications
More informationwritten by Harvard Medical School COPD It Can Take Your Breath Away www.patientedu.org/copd
written by Harvard Medical School COPD It Can Take Your Breath Away www.patientedu.org/copd What Is COPD? COPD stands for chronic obstructive pulmonary disease. There are two major diseases included in
More informationTests. Pulmonary Functions
Pulmonary Functions Tests Static lung functions volumes Dynamic lung functions volume and velocity Dynamic Tests Velocity dependent on Airway resistance Resistance of lung tissue to change in shape Dynamic
More informationBackground information
Background information Asthma Asthma is a complex disease affecting the lungs that can be managed but cannot be cured. 1 Asthma can be controlled well in most people most of the time, although some people
More informationInsights for Improvement: Advancing COPD Care Through Quality Measurement. An NCQA Insights for Improvement Publication
2009 Insights for Improvement: Advancing COPD Care Through Quality Measurement An NCQA Insights for Improvement Publication Chronic obstructive pulmonary disease (COPD) includes chronic bronchitis, emphysema,
More information3/11/15. 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 informationCOPD. Julia Bott. Laura Cornish. Consultant Physiotherapist. Respiratory Specialist Physiotherapist Respiratory Care Team, Virgin Care, Chertsey
COPD Julia Bott Consultant Physiotherapist Laura Cornish Respiratory Specialist Physiotherapist Respiratory Care Team, Virgin Care, Chertsey Acknowledgements Wayomi Perera, MD, MRCP Consultant in Respiratory
More informationBreathing Easier In Tennessee: Employers Mitigate Health and Economic Costs of Chronic Obstructive Pulmonary Disease
Breathing Easier In Tennessee: Employers Mitigate Health and Economic Costs of Chronic Obstructive Pulmonary Disease By John W. Walsh, Co-Founder and President of the COPD Foundation Breathing Easier In
More informationSandwell Community Respiratory Service
Contents Page Community Respiratory Service 2 Service times and locations 3 Oxygen Service 4 Pulmonary Rehabilitation 5 Maintenance Programme 6 Occupational Therapy 7 Dietary support and advice 7 Weatherwise
More informationThe Right Medicines Can Help You Get Control of Asthma. BlueCare SM TennCareSelect
The Right Medicines Can Help You Get Control of Asthma BlueCare SM TennCareSelect WHEEZING. COUGHING. SHORTNESS OF BREATH. CHEST TIGHTNESS. If you or a family member has asthma, you know these symptoms
More informationRheumatoid Arthritis. GP workshop 15 January 2011
Rheumatoid Arthritis GP workshop 15 January 2011 Case 1 A 72 year old Malay woman with RA comes for routine follow up. She feels generally unwell in the last 5 days. Appetite is fair. Her joints are fine.
More informationPCOM 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