Kavita Ratarasarn 4/6/16
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1 Kavita Ratarasarn 4/6/16
2 Delineate the principles involved in management of COPD Identify common issues that may affect treatment in elderly
3 Global Strategy for Diagnosis, Management and Prevention of COPD Definition of COPD n n COPD, a common preventable and treatable disease, is characterized by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lung to noxious particles or gases. Exacerbations and comorbidities contribute to the overall severity in individual patients Global Initiative for Chronic Obstructive Lung Disease
4 Global Strategy for Diagnosis, Management and Prevention of COPD Diagnosis of COPD SYMPTOMS shortness of breath chronic cough sputum EXPOSURE TO RISK FACTORS tobacco occupation indoor/outdoor pollution SPIROMETRY: Required to establish diagnosis 2015 Global Initiative for Chronic Obstructive Lung Disease
5 5 FEV 1 = 4L Normal Volume, liters FVC = 5L FEV 1 /FVC = 0.8 FEV 1 = 1.8L FVC = 3.2L Obstructive 1 FEV 1 /FVC = Time, seconds 2015 Global Initiative for Chronic Obstructive Lung Disease
6 Relieve symptoms Improve exercise tolerance Improve health status Reduce symptoms Prevent disease progression Prevent and treat exacerbations Reduce mortality Reduce risk 2015 Global Initiative for Chronic Obstructive Lung Disease
7 Symptoms Airflow limitation using spirometry Risk of exacerbations >= 2 exacerbations/year or FEV 1 < 50 % : indicators of high risk. Assess comorbidities => Individualized treatment for patients with COPD to reduce symptoms and reduce risk 2015 Global Initiative for Chronic Obstructive Lung Disease
8 Smoking cessation, Identify & treat Comorbidities Roflumilast: chr bronchitis+ repeated exac.
9 COPD patients are at increased risk for: Cardiovascular diseases Osteoporosis Respiratory infections Anxiety and Depression Diabetes Lung cancer Bronchiectasis These comorbid conditions may influence mortality and hospitalizations and should be looked for routinely, and treated appropriately Global Initiative for Chronic Obstructive Lung Disease
10 Dyspnea may be attributed to other diseases: cardiac, other lung diseases. Patients may limit activity to compensate for dyspnea, may assume dyspnea results from their aging process. Diagnosis: specific questions regarding symptoms (cough, exercise tolerance, sputum), history of exposure + spirometry* *FEV1:FVC <70% may overdiagnose obstruction in up to 35% of elderly, never-smoker, asymptomatic subjects Risk of over-diagnosis of COPD in asymptomatic elderly never-smokers. EurRespir J 2002;20:
11 Physical/cognitive disabilities may affect usage of inhalers Clin Interv Aging. 2014; 9:
12
13 Poor control of symptoms Worsening of the quality of life Increasing number of relapses and more frequent need for health-care services (35-45% of the disease-related costs) Increase in health-care expenditure Increased mortality
14 Medications Side Effects B2 agonist Tremors, palpitations, arrhythmias, hypokalemia Anticholinergic Urinary retention, mucosal dryness Steroid Thrush, dysphonia, pneumonia, {osteoporosis, elevated BP, myopathy, glaucoma, thin skin/bruising/slower healing, cataract, adrenal suppression, DM) Theophylline Tachyarrhythmias, insomnia, seizures, nausea/vomiting
15 Patient adherence in chronic obstructive pulmonary disease is multifactorial and is influenced by the patient, the physician and society. J Bourbeau, and S J Bartlett Thorax 2008;63: Copyright BMJ Publishing Group Ltd & British Thoracic Society. All rights reserved.
16 Increased risk of Complications Transplant usually not an option for >65 yrs Careful patient selection for bullectomy, lung volume resection surgery
17 COPD is a common disease Primary management principles are based on GOLD guidelines Goals of treatment: relieve symptoms, prevent complications Management in elderly involves consideration of age specific factors that affect diagnosis as well as treatment Management of comorbidities is an essential component of COPD management
18
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