COPD and Asthma Update. April 29 th, 2017 Rachel M Taliercio, DO Staff, Respiratory Institute
|
|
- Sylvia Chase
- 6 years ago
- Views:
Transcription
1 COPD and Asthma Update April 29 th, 2017 Rachel M Taliercio, DO Staff, Respiratory Institute
2 What we ll be talking about COPD: diagnosis, management of stable COPD, COPD exacerbations Asthma: diagnosis, comorbidities, management Asthma/COPD Overlap: phenotype, management Smoking cessation: pearls, electronic cigarettes
3 55 year old male, current smoker (25 pack year history), presents with several months of worsening dyspnea on exertion. Has a chronic cough which he attributes to smoking. Two colds this past year, took him weeks to recover from each episode. Your diagnosis: 1. Asthma 2. COPD 3. Asthma/COPD Overlap 4. Unable to determine
4 55 year old male, current smoker (25 pack year history), presents with several months of worsening dyspnea on exertion. Has a chronic cough which he attributes to smoking. Two colds this past year, took him weeks to recover from each episode. Your diagnosis: 1. Asthma 2. COPD 3. Asthma/COPD Overlap 4. Unable to determine
5 COPD: Spirometry is Required to Make the Diagnosis Assesses lung function by measuring expiratory volumes and flow rates Obtain spirometry on all patients with chronic cough, sputum production or dyspnea
6 COPD = Fixed Airflow Obstruction Airflow limitation that is irreversible or partially reversible with bronchodilator FEV1/FVC ratio < 0.70 or < LLN FEV1: measure of severity of airflow obstruction Spirometry is not recommended as screening tool
7
8 COPD and Smoking Majority of risk for developing COPD is from smoking (~80%) 15 to 20% of smokers develop clinically significant COPD Symptoms typically develop after 20 or more pack years Smokers lose lung function at an accelerated rate Quitting is beneficial at any age, more pronounced in earlier quitters Passive smoke exposure has been implicated as a cause of COPD (affects women > men) Kohansal et al. Am J Respir Crit Care Med 2009;180:3 10
9 81 year old female, never smoker, presents with several month history of dyspnea on exertion. No associated cough, wheeze or chest tightness. No history of asthma. No history of chronic respiratory illness as a child or adult. Homemaker. No significant second hand smoke exposure.
10
11 COPD in Never Smokers Up to 20% of patients with COPD More common in women Typically moderate to severe obstruction Additional risk factors: low BMI, low education level, history of asthma, severe respiratory infections in childhood Occupational exposures: organic dust, biomass fuel Chest 2011; 139(4):
12
13
14 COPD: Management Goal of treatment: to improve symptoms and exercise capacity, reduce exacerbations and hospitalizations Considerations for initial therapy: Symptoms FEV1 History of exacerbations Past exacerbation history is the best predictor of future flares
15 63 yo male, former smoker, new diagnosis of COPD. FEV1 75% predicted (mild obstruction). Reports occasional dyspnea. No history of COPD flare. Which of the following is indicated? 1. Short-acting bronchodilator 2. Short-acting bronchodilator and flu vaccine 3. Short-acting bronchodilator, flu vaccine, long-acting bronchodilator (LABA or LAMA) 4. Short-acting bronchodilator, flu vaccine, combination therapy (ICS/LABA)
16 63 yo male, former smoker, new diagnosis of COPD. FEV1 75% predicted (mild obstruction). Reports occasional dyspnea. No history of COPD flare. Which of the following is indicated? 1. Short-acting bronchodilator 2. Short-acting bronchodilator and flu vaccine 3. Short-acting bronchodilator, flu vaccine, long-acting bronchodilator (LABA or LAMA) 4. Short-acting bronchodilator, flu vaccine, combination therapy (ICS/LABA)
17 Short-Acting Bronchodilators (SABA)
18 Short-Acting Bronchodilators (SAMA)
19 57 yo female with COPD here to establish care. FEV1 60% predicted (moderate obstruction). Has noticed breathlessness during walking on a flat surface. No h/o flare. What is the recommended first-line inhaled therapy? 1. Short-acting bronchodilator 2. Inhaled steroids 3. Long-acting bronchodilator 4. Long-acting bronchodilator/inhaled steroid combination
20 57 yo female with COPD here to establish care. FEV1 60% predicted (moderate obstruction). Has noticed breathlessness during walking on a flat surface. No h/o flare. What is the recommended first-line inhaled therapy? 1. Short-acting bronchodilator 2. Inhaled steroids 3. Long-acting bronchodilator 4. Long-acting bronchodilator/inhaled steroid combination
21 COPD: Bronchodilators (BD) are Key Long-Acting Bronchodilators
22 Same patient, here for six month follow up visit. Went to urgent care two months ago, diagnosed with bronchitis. Given prednisone and antibiotics. Taking Tiotropium daily. Still breathless with activity. What is the best next step? 1. Continue long-acting bronchodilator, add combination therapy (ICS/LABA) 2. Switch from long-acting bronchodilator to combination therapy (ICS/LABA) 3. Switch from long-acting bronchodilator monotherapy to dual BD therapy (LABA/LAMA) 4. Continue long-acting BD and add ICS
23 Same patient, here for six month follow up visit. Went to urgent care two months ago, diagnosed with bronchitis. Given prednisone and antibiotics. Taking Tiotropium daily. Still breathless with activity. What is the best next step? 1. Continue long-acting bronchodilator, add combination therapy (ICS/LABA) 2. Switch from long-acting bronchodilator to combination therapy (ICS/LABA) 3. Switch from long-acting bronchodilator monotherapy to dual BD therapy (LABA/LAMA) 4. Continue long-acting BD and add ICS
24 FLAME trial LABA/LAMA vs. ICS/LABA 17% reduction in moderate-to-severe exacerbations with dual bronchodilator therapy
25 Dual Bronchodilators (LABA/LAMA)
26 COPD: When to Think About Inhaled Steroids Moderate to severe COPD Repeated exacerbations Low quality of life Asthma-COPD Overlap Always in combination with LABA Risks associated with use: Oral candidiasis, hoarseness Skin bruising Pneumonia
27
28 Which of the following has been shown to impact survival in COPD? 1. Smoking cessation 2. Oxygen therapy (in patients with severe chronic resting hypoxemia) 3. Maintenance medication 4. 1 and 2 5. All of the above
29 Which of the following has been shown to impact survival in COPD? 1. Smoking cessation 2. Oxygen therapy (in patients with severe chronic resting hypoxemia) 3. Maintenance medication 4. 1 and 2 5. All of the above
30 Pulmonary Rehab Improves dyspnea and exercise capacity Reduces hospitalization and improves QOL in patients with a recent exacerbation What your patients should expect: Exercise training Education Inspiratory muscle training
31 COPD Exacerbations: Ambulatory Management GOLD 2017: worsening of respiratory symptoms that result in additional therapy Give antibiotics Infection implied in up to 80% of episodes Shortened recovery time, reduces treatment failure, increases time between flares Give oral steroids Improve lung function, trend toward fewer hospitalizations Dosage? Duration? (no more than 10 to 14 days) Anthonisen NR et al. Ann Intern Med 1987;106:196 Wedzicha et al. ERJ 2017; 49: Sethi S. Chest 2000;117:380S-385S
32 COPD Exacerbations: Antibiotic Selection Anzueto A et al. Am J Med Sci 2010; 340(4): Used with permission courtesy of Dr. Aboussouan
33 COPD: When to Refer Disease onset < 40 years old Frequent exacerbations (> 2 or more per year) despite therapy Severe airflow obstruction (FEV1 < 50%) Patients on oxygen therapy Significant comorbidities Considering add-on therapy
34 Asthma
35 What percent of study participants with physician-diagnosed asthma had no evidence of current asthma (% of patients in whom asthma was ruled out)? 1. 10% 2. 20% 3. 30% 4. 50% 5. 60% Aaron et al. JAMA. 2017; 317(3):
36 What percent of study participants with physician-diagnosed asthma had no evidence of current asthma (% of patients in whom asthma was ruled out)? 1. 10% 2. 20% 3. 30% 4. 50% 5. 60% Aaron et al. JAMA. 2017; 317(3):
37 Asthma: Diagnosis Chronic airway inflammation shortness of breath, cough, wheezing, chest tightness Variable symptoms (episodic) Variable airflow limitation Symptoms vary over time and in intensity
38 Airflow Obstruction with Positive Bronchodilator Response
39 Asthma: Diagnosis Whenever possible, confirm diagnosis before starting controller therapy Clinical urgency or other diagnosis unlikely start empiric treatment Then diagnostic testing within 1 to 3 months
40 Asthma Triggers
41 Your patient has a clinical history suggestive of asthma. You order lung function testing and it is normal, no reversibility. What is the best next step? 1. Consider alternative diagnosis 2. Treat empirically for asthma 3. Order methacholine challenge test 4. Check exhaled nitric oxide
42 Your patient has a clinical history suggestive of asthma. You order lung function testing and it is normal, no reversibility. What is the best next step? 1. Consider alternative diagnosis 2. Treat empirically for asthma 3. Order methacholine challenge test 4. Check exhaled nitric oxide
43 Methacholine Challenge Test
44 Exhaled Nitric Oxide (eno, FENO) > 50 ppb: eosinophilic airway inflammation High eno suggests steroid responsiveness Useful in monitoring inflammation 20% reduction = steroid responsiveness Assessment tool for adherence Not a good diagnostic test for asthma Also elevated in rhinosinusitis/atopy, eosinophilic bronchitis, COPD, eczema
45 Asthma is Heterogenous
46 Asthma Phenotypes Allergic asthma Non-allergic asthma Late-onset asthma Asthma with fixed airflow obstruction Asthma with obesity
47 Your patient has allergic asthma and you tell him the cat is a major trigger. He tells you his girlfriend will break up with him before she gets rid of the cat. Which of the following are strategies to reduce exposure? 1. Remove carpets/hepa filter on vacuum 2. Brush pet outside to remove dander 3. Remove the cat from the bedroom 4. Change your clothes after prolonged exposure to the animal 5. All of the above
48 Your patient has allergic asthma and you tell him the cat is a major trigger. He tells you his girlfriend will break up with him before she gets rid of the cat. Which of the following are strategies to reduce exposure? 1. Remove carpets/hepa filter on vacuum 2. Brush pet outside to remove dander 3. Remove the cat from the bedroom 4. Change your clothes after prolonged exposure to the animal 5. All of the above
49 Which of the following is the most common cause of uncontrolled asthma: 1. Poor adherence 2. Incorrect inhaler technique 3. Incorrect diagnosis 4. Inadequate therapy 5. Persistent exposure to triggers
50 Which of the following is the most common cause of uncontrolled asthma: 1. Poor adherence 2. Incorrect inhaler technique 3. Incorrect diagnosis 4. Inadequate therapy 5. Persistent exposure to triggers
51 Asthma Management: High Value, Low Cost Increase delivery of drug into the lung Increased potency of inhaled steroids Reduction in oropharyngeal candidiasis Toogood et al. AJRCCM 1984; 129:
52 Asthma Management: Anti-Inflammatory is the Standard
53 Combination Therapy: ICS/LABA
54 Asthma Management: Additional Therapies Anti-leukotrienes: Montelukast (Singulair ), Zafirlukast (Accolate ), Zileuton (Zyflo ) Biologic agents/monoclonal antibody: Omalizumab (Xolair ), Mepolizumab (Nucala ), Reslizumab (Cinqair ) Long-acting muscarinic antagonist (LAMA): Tiotropium (Spiriva )
55 Stepwise Approach to Asthma Therapy: Key Points Step 1: consider low dose ICS SABA alone for pts with asthma sxs less than twice/month, no nighttime sxs, no risks/hx flares ICS reduce risk of severe exacerbations Step 2: low dose ICS other options: LTRA, low dose theophylline Before considering step-up to 3 or 4: Check diagnosis, inhaler technique, exposures, adherence
56 Stepwise Approach to Asthma Therapy: Key Points Step 3: low dose ICS/LABA other options: med/high dose ICS OR low dose ICS + LTRA) Step 4: med/high dose ICS/LABA (add tiotropium) Step 5: refer for add-on treatment Step 3 to 5 reliever therapy: SABA or low dose ICS/LABA
57 Reddel et al. Eur Respir J 2015; 46:
58 >= 20 : well controlled : not well controlled 15 : very poorly controlled Asthma Control Test QualityMetric incorporated,
59 Asthma Management: Assess for Comorbidities Upper airway disease: chronic rhinosinusitis, nasal polyposis Obstructive sleep apnea GERD (no role for treatment if patient asymptomatic) Paradoxical vocal fold motion (formally known as vocal cord dysfunction) Obesity Depression
60 Asthma-COPD Overlap Nearly 25% of patients with COPD report history of asthma Features of both: more symptoms, increased rate of exacerbations, more likely hospitalized, more rapid decline lung function Younger, women men, higher BMI, fewer pack years of smoking, greater % African- Americans Compared to COPD alone: similar lung function, less emphysema on imaging Eur Respir J 2014; 44:
61 Asthma-COPD Overlap Suggested criteria Age > 40 FEV1/FVC < 0.70 Exposure to cigarette smoke Previous/current history of asthma/atopy Marked bronchodilator response (>400 ml) IgE level > 100 Blood eosinophils > 5% Treatment response is different Early initiation of inhaled corticosteroids is recommended Chest. 2015; doi: /chest
62 Your patient is interested in quitting smoking. Which of the following treatment methods has the highest abstinence rate? 1. Nicotine patch 2. Nicotine patch + nicotine gum 3. Buproprion SR (Zyban) 4. Nicotine patch + Buproprion 5. Varencycline (Chantix)
63 Your patient is interested in quitting smoking. Which of the following treatment methods has the highest abstinence rate? 1. Nicotine patch 2. Nicotine patch + nicotine gum 3. Buproprion SR (Zyban) 4. Nicotine patch + Buproprion 5. Varencycline (Chantix)
64 Your patient is overweight and concerned about weight gain after smoking cessation. Which of the following would be a good option? 1. Nicotine patch 2. Nicotine patch + nicotine gum 3. Buproprion SR (Zyban) 4. Nicotine patch + Buproprion 5. Varencycline (Chantix)
65 Your patient is overweight and concerned about weight gain after smoking cessation. Which of the following would be a good option? 1. Nicotine patch 2. Nicotine patch + nicotine gum 3. Buproprion SR (Zyban) 4. Nicotine patch + Buproprion 5. Varencycline (Chantix)
66 Electronic Cigarettes Most popular tobacco product among high school and middle school students Highest prevalence (14%) in young adults 18 to 24 years old
67 The Power of Advertising Perceived as a tool to quit or reduce smoking Similar efficacy to nicotine replacement therapy
68 Electronic Cigarettes: Lack of Evidence of Harm Safety Normalization of smoking behavior Gateway to other tobacco products Students identify use of e-cigarettes as a significant factor in being likely to try tobacco products Known pulmonary toxicity FDA now has authority to prohibit sale to minors
69 Thank You!
Clinical Implications of Asthma Phenotypes. Michael Schatz, MD, MS Department of Allergy
Clinical Implications of Asthma Phenotypes Michael Schatz, MD, MS Department of Allergy Definition of Phenotype The observable properties of an organism that are produced by the interaction of the genotype
More informationPFT s / 2017 Pulmonary Update. Eric S. Papierniak, DO University of Florida NF/SG VHA
PFT s / 2017 Pulmonary Update Eric S. Papierniak, DO University of Florida NF/SG VHA Outline Overview of pulmonary function testing Uses/indications/limitations Technical aspects Basics of interpretation
More informationAsthma COPD Overlap (ACO)
Asthma COPD Overlap (ACO) Dr Thomas Brown Consultant Respiratory Physician Thomas.Brown@porthosp.nhs.uk Dr Hitasha Rupani Consultant Respiratory Physician Hitasha.rupani@porthosp.nhs.uk What is Asthma
More informationBiologic Agents in the treatment of Severe Asthma
Biologic Agents in the treatment of Severe Asthma Daniel L Maxwell, D.O., FACOI, FAASM Clinical Assistant Professor of Medicine Michigan State University College of Osteopathic Medicine College of Human
More informationGlobal Initiative for Asthma (GINA) What s new in GINA 2017?
Global Initiative for Asthma (GINA) GINA Global Strategy for Asthma Management and Prevention Asthma-COPD overlap The word syndrome has been removed from the previous term asthma-copd overlap syndrome
More informationCurrent Approaches to Asthma & COPD
10/11/18 Current Approaches to Asthma & COPD Lekshmi Santhosh, M.D. Assistant Professor, Pulm/Critical Care & Hosp Med Primary Care Medicine: Principles & Practice 10.11.2018 Revisiting the Dutch Hypothesis:
More informationImproving Outcomes in the Management & Treatment of Asthma. April 21, Spring Managed Care Forum
Improving Outcomes in the Management & Treatment of Asthma April 21, 2016 2016 Spring Managed Care Forum David M. Mannino, M.D. Professor Department of Preventive Medicine and Environmental Health University
More information#POMAD8 #ChoosePOMA #POMAD8 #ChoosePOMA #POMAD8 #ChoosePOMA
Where There s Smoke There s Obstruction Stephen G. Basheda, D.O., F.C.C.P. 1 Disclosures Dr. Basheda is an independent contractor for AstraZeneca Pharmaceuticals, LP and GlaxoSmithKline and on the speaker
More informationCOPD: Current Medical Therapy
COPD: Current Medical Therapy Angela Golden, DNP, FNP-C, FAANP Owner, NP from Home, LLC Outcomes As a result of this activity, learners will be able to: 1. List the appropriate classes of medications for
More information2/4/2019. GOLD Objectives. GOLD 2019 Report: Chapters
GOLD Objectives To provide a non biased review of the current evidence for the assessment, diagnosis and treatment of patients with COPD. To highlight short term and long term treatment objectives organized
More informationCOPD. Helen Suen & Lexi Smith
COPD Helen Suen & Lexi Smith What is COPD? Chronic obstructive pulmonary disease: a non reversible, long term lung disease Characterized by progressively limited airflow and an inability to perform full
More informationASTHMA-COPD OVERLAP SYNDROME 2018: What s All the Fuss?
ASTHMA-COPD OVERLAP SYNDROME 2018: What s All the Fuss? Randall W. Brown, MD MPH AE-C Association of Asthma Educators Annual Conference July 20, 2018 Phoenix, Arizona FACULTY/DISCLOSURES Randall Brown,
More informationUpdate in Pulmonology Update in Medicine and Primary Care November 11, 2017
Update in Pulmonology Update in Medicine and Primary Care November 11, 2017 Denitza P. Blagev, MD Pulmonary & Critical Care Medicine Director, Schmidt Chest Clinic Director, Lung Cancer Screening Program
More informationChronic obstructive pulmonary disease
0 Chronic obstructive pulmonary disease Implementing NICE guidance June 2010 NICE clinical guideline 101 What this presentation covers Background Scope Key priorities for implementation Discussion Find
More informationCynthia S. Kelly, M.D. Professor of Pediatrics Eastern Virginia Medical School Division Director Allergy Children s Hospital of The King s Daughters
Cynthia S. Kelly, M.D. Professor of Pediatrics Eastern Virginia Medical School Division Director Allergy Children s Hospital of The King s Daughters Disclosures Speakers bureau of Novartis and Genentech
More informationHow to treat COPD? What is the mechanism of dyspnea? Smoking cessation
: The Increasing Role of the FP Alan Kaplan, MD, CCFP(EM) Presented at the Primary Care Today: Education Conference and Medical Exposition, Toronto, Ontario, May 2006. Chronic obstructive pulmonary disease
More informationCOPD: A Renewed Focus. Disclosures
COPD: A Renewed Focus Heath Latham, MD Assistant Professor Division of Pulmonary and Critical Care Medicine Disclosures No Business Interests No Consulting No Speakers Bureau No Off Label Use to Discuss
More information(Asthma) Diagnosis, monitoring and chronic asthma management
Dubai Standards of Care 2018 (Asthma) Diagnosis, monitoring and chronic asthma management Preface Asthma is one of the most common problem dealt with in daily practice. In Dubai, the management of chronic
More informationAsma e BPCO: le strategie terapeutiche
Asma e BPCO: le strategie terapeutiche Dott. Marco Contoli ctm@unife.it Sezione di Medicina Interna e Cardio-Respiratoria Dipartimento di Scienze Mediche Università di Ferrara COPD Definition Chronic Obstructive
More informationRESPIRATORY CARE IN GENERAL PRACTICE
RESPIRATORY CARE IN GENERAL PRACTICE Definitions of Asthma and COPD Asthma is due to inflammation of the air passages in the lungs and affects the sensitivity of the nerve endings in the airways so they
More informationProvider Respiratory Inservice
Provider Respiratory Inservice 2 Welcome Opening Remarks We will cover: Definition of Asthma & COPD Evidence based guidelines for diagnosis, evaluation, and management of asthma Evidence based guidelines
More informationAsthma Management Updates: A Focus on Long-acting Muscarinic Antagonists and Intermittent Inhaled Corticosteroid Dosing
Asthma Management Updates: A Focus on Long-acting Muscarinic Antagonists and Intermittent Inhaled Corticosteroid Dosing Diana M. Sobieraj, PharmD, BCPS Assistant Professor University of Connecticut School
More informationAmanda Hess, MMS, PA-C President-Elect, AAPA-AAI Arizona Asthma and Allergy Institute Scottsdale, AZ
Amanda Hess, MMS, PA-C President-Elect, AAPA-AAI Arizona Asthma and Allergy Institute Scottsdale, AZ Financial Disclosures Advanced Practiced Advisory Board for Circassia Learning Objectives 1. Briefly
More informationSABA: VENTOLIN EVOHALER (SALBUTAMOL) SAMA: ATROVENT IPRATROPIUM. Offer LAMA (discontinue SAMA) OR LABA
COPD GUIDELINES DIAGNOSIS >35 years of age Symptoms of cough, breathlessness, sputum, wheeze, Risk factor (SMOKING) Spirometry (post bronchodilator) FEV1/FVC = 0.7 ENCOURAGE PATIENTS TO BRING INHALERS
More informationJOINT CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) MANAGEMENT GUIDELINES
JOINT CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) MANAGEMENT GUIDELINES Authors Dr Ian Benton Respiratory Consultant COCH Penny Rideal Respiratory Nurse COCH Kirti Burgul Respiratory Pharmacist COCH Pam
More informationDefining COPD. Georgina Grantham Community Respiratory Team Leader/ Respiratory Nurse Specialist
Defining COPD Georgina Grantham Community Respiratory Team Leader/ Respiratory Nurse Specialist Defining COPD Chronic Obstructive Pulmonary Disease (COPD) is a common, preventable and treatable disease
More informationUp in FLAMES: Stable Chronic Obstructive Pulmonary Disease (COPD) Management. Colleen Sakon, PharmD BCPS September 27, 2018
Up in FLAMES: Stable Chronic Obstructive Pulmonary Disease (COPD) Management Colleen Sakon, PharmD BCPS September 27, 2018 Disclosures I have no actual or potential conflicts of interest 2 Objectives Summarize
More informationCOPD/Asthma. Prudence Twigg, AGNP
COPD/Asthma Prudence Twigg, AGNP COPD/Asthma Qualifying Diagnosis Known diagnosis of COPD/asthma or CXR showing COPD with hyperinflated lungs and no infiltrates + two or more: Wheezing, SOB, increased
More informationTHE CHALLENGES OF COPD MANAGEMENT IN PRIMARY CARE An Expert Roundtable
THE CHALLENGES OF COPD MANAGEMENT IN PRIMARY CARE An Expert Roundtable This activity is supported by an educational grant from Sunovion Pharmaceuticals Inc. COPD in the United States Third leading cause
More informationChanging Landscapes in COPD New Zealand Respiratory Conference
Changing Landscapes in COPD New Zealand Respiratory Conference Dr Robert Young BMedSc MBChB DPhil (Oxon) FRACP FRCP Associate Professor Consultant Physician Changing Landscapes in COPD: Summary 1. Overview
More informationCOPD, Asthma, Or Something In Between? Sharon R. Rosenberg Assistant Professor of Medicine Northwestern University December 4, 2013
COPD, Asthma, Or Something In Between? Sharon R. Rosenberg Assistant Professor of Medicine Northwestern University December 4, 2013 None Disclosures Definitions Asthma Asthma is a chronic inflammatory
More informationAdvances in the management of chronic obstructive lung diseases (COPD) David CL Lam Department of Medicine University of Hong Kong October, 2015
Advances in the management of chronic obstructive lung diseases (COPD) David CL Lam Department of Medicine University of Hong Kong October, 2015 Chronic obstructive pulmonary disease (COPD) COPD in Hong
More informationGINA. At-A-Glance Asthma Management Reference. for adults, adolescents and children 6 11 years. Updated 2017
GINA At-A-Glance Asthma Management Reference for adults, adolescents and children 6 11 years Updated 2017 This resource should be used in conjunction with the Global Strategy for Asthma Management and
More informationNG80. Asthma: diagnosis, monitoring and chronic asthma management (NG80)
Asthma: diagnosis, monitoring and chronic asthma management (NG80) NG80 NICE has checked the use of its content in this product and the sponsor has had no influence on the content of this booklet. NICE
More information12/18/2017. Disclosures. Asthma Management Updates: A Focus on Long-acting Muscarinic Antagonists and Intermittent Inhaled Corticosteroid Dosing
Asthma Management Updates: A Focus on Long-acting Muscarinic Antagonists and Intermittent Inhaled Corticosteroid Dosing Diana M. Sobieraj, PharmD, BCPS Assistant Professor University of Connecticut School
More informationUpdate on heterogeneity of COPD, evaluation of COPD severity and exacerbation
Update on heterogeneity of COPD, evaluation of COPD severity and exacerbation Yung-Yang Liu, MD Taipei Veterans General Hospital Aug 29, 2015 G O lobal Initiative for Chronic bstructive L D ung isease
More informationAsthma and COPD in older people lumping or splitting? Christine Jenkins Concord Hospital Woolcock Institute of Medical Research
Asthma and COPD in older people lumping or splitting? Christine Jenkins Concord Hospital Woolcock Institute of Medical Research Concord Hospital Woolcock Institute of Medical Research Joe has asthma What
More informationAsthma Pathophysiology and Treatment. John R. Holcomb, M.D.
Asthma Pathophysiology and Treatment John R. Holcomb, M.D. Objectives Definition of Asthma Epidemiology and risk factors of Asthma Pathophysiology of Asthma Diagnostics test of Asthma Management of Asthma
More informationCOPD or not COPD, that is the question.
COPD or not COPD, that is the question. Asthma-COPD Overlap Syndrome: ACOS Do we really need this? Michelle Harkins Disclosure Slide Slide help - William Busse, MD Organizational Interests ATS, ACCP, ACP
More informationSyllabi/Slides for this program are a supplement to the live CME session and are not intended for other purposes.
10:50-11:50am Case Studies in Pulmonary Medicine for the Primary Care Clinician SPEAKERS Timothy J. Scialla, MD Common Shortcuts/Common Misperceptions Smoking + Dyspnea = COPD Hospitalization for cough
More information7/7/2015. Somboon Chansakulporn, MD. History of variable respiratory symptoms. 1. Documented excessive variability in PFT ( 1 test)
Definition of Asthma GINA 2010: Chronic inflammatory disorder of the airways Airway hyper-responsiveness Recurrent wheezing, breathlessness, chest tightness, coughing Variable, reversible airflow obstruction
More informationCHRONIC OBSTRUCTIVE LUNG DISEASE (COPD), BRONCHIAL ASTHMA
CHRONIC OBSTRUCTIVE LUNG DISEASE (COPD), BRONCHIAL ASTHMA GOLD GINA Chronic Obstructive Pulmonary Disease (COPD) COPD is currently the fourth leading cause of death in the world.1 COPD is projected to
More informationLead team presentation: Roflumilast for treating chronic obstructive pulmonary disease [ID984]
Lead team presentation: Roflumilast for treating chronic obstructive pulmonary disease [ID984] 1 st Appraisal Committee meeting Background & Clinical Effectiveness John McMurray 11 th January 2016 For
More informationGlobal 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 These guidelines are provided to assist physicians and other clinicians in making decisions
More informationCOPD is a syndrome of chronic limitation in expiratory airflow encompassing emphysema or chronic bronchitis.
1 Definition of COPD: COPD is a syndrome of chronic limitation in expiratory airflow encompassing emphysema or chronic bronchitis. Airflow obstruction may be accompanied by airway hyper-responsiveness
More informationCOPD GOLD Guidelines & Barnet inhaler choices. Dr Dean Creer, Respiratory Consultant, Royal Free London NHS Foundation Trust
COPD GOLD Guidelines & Barnet inhaler choices Dr Dean Creer, Respiratory Consultant, Royal Free London NHS Foundation Trust GOLD 2017 Report: Chapters 1. Definition and Overview 2. Diagnosis and Initial
More informationTurning Science into Real Life Roflumilast in Clinical Practice. Roland Buhl Pulmonary Department Mainz University Hospital
Turning Science into Real Life Roflumilast in Clinical Practice Roland Buhl Pulmonary Department Mainz University Hospital Therapy at each stage of COPD I: Mild II: Moderate III: Severe IV: Very severe
More informationHow to distinguish between uncontrolled and severe asthma
How to distinguish between uncontrolled and severe asthma Watch patient using their inhaler. Discuss adherence and barriers to use Compare inhaler technique with a devicespecific checklist, and correct
More informationIntegrated Cardiopulmonary Pharmacology Third Edition
Integrated Cardiopulmonary Pharmacology Third Edition Chapter 13 Pharmacologic Management of Asthma, Chronic Bronchitis, and Emphysema Multimedia Directory Slide 7 Slide 12 Slide 60 COPD Video Passive
More informationChronic Obstructive Pulmonary Disease (COPD) KAREN ALLEN MD PULMONARY & CRITICAL CARE MEDICINE VA HOSPITAL OKC / OUHSC
Chronic Obstructive Pulmonary Disease (COPD) KAREN ALLEN MD PULMONARY & CRITICAL CARE MEDICINE VA HOSPITAL OKC / OUHSC I have no financial disclosures Definition COPD is a preventable and treatable disease
More informationOPTIMIZING MANAGEMENT OF COPD IN THE PRACTICE SETTING 10/16/2018 DISCLOSURES I have no financial or other disclosures
OPTIMIZING MANAGEMENT OF COPD IN THE PRACTICE SETTING J. Michael Fuller, MD, MEd, FACP, FCCP Associate Professor of Medicine University of South Carolina Greenville DISCLOSURES I have no financial or other
More informationDifficult Asthma Assessment: A systematic approach
Difficult Asthma Assessment: A systematic approach Dr Naghmeh Radhakrishna Respiratory, Sleep & Allergy Physician Allergy, Asthma & Clinical Immunology Service The Alfred Hospital Melbourne, Australia
More informationGlobal Initiative for Asthma (GINA) What s new in GINA 2016?
Global Initiative for Asthma (GINA) What s new in GINA 2016? GINA Global Strategy for Asthma Management and Prevention GINA: A Brief History Established in 1993 Collaboration between NHLBI and WHO Multiple
More informationAsthma in Day to Day Practice
Asthma in Day to Day Practice VIJAY.K.VANAM Financial relationships: Disclosures Employed at Mercy Medical Center, Mason City. Nonfinancial relationships: I receive no financial gain from any pharmaceutical
More informationThis is a cross-sectional analysis of the National Health and Nutrition Examination
SUPPLEMENTAL METHODS Study Design and Setting This is a cross-sectional analysis of the National Health and Nutrition Examination Survey (NHANES) data 2007-2008, 2009-2010, and 2011-2012. The NHANES is
More informationCOPD. Breathing Made Easier
COPD Breathing Made Easier Catherine E. Cooke, PharmD, BCPS, PAHM Independent Consultant, PosiHleath Clinical Associate Professor, University of Maryland School of Pharmacy This program has been brought
More informationCOPD: Applying New Guidelines to Optimizing Evaluation and Treatment
Transcript Details This is a transcript of a continuing medical education (CME) activity accessible on the ReachMD network. Additional media formats for the activity and full activity details (including
More informationLife-long asthma and its relationship to COPD. Stephen T Holgate School of Medicine University of Southampton
Life-long asthma and its relationship to COPD Stephen T Holgate School of Medicine University of Southampton Definitions COPD is a preventable and treatable disease with some significant extrapulmonary
More informationBiologics in asthma Are we turning the corner? Roland Buhl Pulmonary Department Mainz University Hospital
Biologics in asthma Are we turning the corner? Roland Buhl Pulmonary Department Mainz University Hospital Biologics in asthma - are we turning the corner? Allergic asthma anti - IgE Allergic airway inflammation
More informationThree s Company - The role of triple therapy in chronic obstructive pulmonary disease (COPD)
Three s Company - The role of triple therapy in chronic obstructive pulmonary disease (COPD) Zahava Picado, PharmD PGY1 Pharmacy Practice Resident Central Texas Veterans Healthcare System Temple, TX October
More informationASTHMA. Dr Liz Gamble BRI
ASTHMA Dr Liz Gamble BRI Diagnosis Clinical: wheeze, breathlessness, chest tightness, cough Variable airflow obstruction: peak flow chart, spirometry with reversibility to bronchodilators Airways hyper-responsiveness
More informationGuideline for the Diagnosis and Management of COPD
Guideline for the Diagnosis and Management of COPD Introduction Chronic obstructive pulmonary disease (COPD) is a respiratory disorder largely caused by smoking. It is characterized by progressive, partially
More informationPeople with asthma who smoke. The combination of asthma, a chronic airway disease, and smoking increases the risk of COPD even more.
COPD Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease that causes obstructed airflow from the lungs. Symptoms include breathing difficulty, cough, sputum (phlegm) production
More informationI have no perceived conflicts of interest or commercial relationships to disclose.
ASTHMA BASICS Michelle Dickens RN FNP-C AE-C Nurse Practitioner/Certified Asthma Educator Ferrell Duncan Allergy/Asthma/Immunology Coordinator, CoxHealth Asthma Center DISCLOSURES I have no perceived conflicts
More informationTreatment Options for Complicated/Severe Asthma. Henry J. Kanarek, MD Kanarek Allergy Asthma Immunology
Treatment Options for Complicated/Severe Asthma Henry J. Kanarek, MD Kanarek Allergy Asthma Immunology www.kallergy.com 913-451-8555 Asthma Epidemiology World Health Organization, Asthma is one of the
More informationAsthma 2015: Establishing and Maintaining Control
Asthma 2015: Establishing and Maintaining Control Webinar for Michigan Center for Clinical Systems Improvement (Mi-CCSI) Karen Meyerson, MSN, APRN, NP-C, AE-C June 16, 2015 Asthma Prevalence Approx. 26
More informationAsthma Therapy 2017 JOSHUA S. JACOBS, M.D.
Asthma Therapy 2017 JOSHUA S. JACOBS, M.D. BACKGROUND-PREVALENCE Asthma is one of the most common chronic diseases worldwide with an estimated 300 million affected individuals Prevalence is increasing
More informationDo We Need Biologics in Pediatric Asthma Management?
Do We Need Biologics in Pediatric Asthma Management? Ting Fan LEUNG, MBChB, MD, FRCPCH, FAAAAI Professor and Chairman Department of Paediatrics The Chinese University of Hong Kong Asthma and Allergy by
More informationChronic Obstructive Pulmonary Disease (COPD) Clinical Guideline
Chronic Obstructive Pulmonary Disease (COPD) Clinical These clinical guidelines are designed to assist clinicians by providing an analytical framework for the evaluation and treatment of patients. They
More informationPrimary Care Medicine: Concepts and Controversies Wed., February 17, 2010 Fiesta Americana Puerto Vallarta, Mexico Update on Asthma and COPD
Primary Care Medicine: Concepts and Controversies Wed., February 17, 2010 Fiesta Americana Puerto Vallarta, Mexico Update on Asthma and COPD Talmadge E. King, Jr., M.D. Krevins Distinguished Professor
More information11/27/18. Challenges in Pulmonary and Critical Care: COPD So Much is New! Faculty. Disclosures
Challenges in Pulmonary and Critical Care: 2018 COPD So Much is New! 1 Faculty Anas Hadeh, MD, FCCP Director, Pulmonary and Critical Care Medicine Fellowship Program Affiliate Assistant Professor of Clinical
More informationDisclosures. Update on COPD & Asthma. Update on the Management of COPD. No Pharma Disclosures. NHLBI - Asthma Clinical Research Network
Update on COPD & Asthma Michael C. Peters, M.D. MAS Division of Pulmonary & Critical Care Medicine Cardiovascular Research Institute University of California San Francisco UCSF Primary Care Medicine San
More informationChronic Obstructive Pulmonary Disease Guidelines and updates
Chronic Obstructive Pulmonary Disease Guidelines and updates October 20, 2018 Saratoga Springs, NY COPD (Chronic obstructive pulmonary disease) is a major cause of mortality and morbidity in the United
More informationCOPD in primary care: reminder and update
COPD in primary care: reminder and update Managing COPD continues to be a major feature of primary care, particularly in practices with a high proportion of M ori and Pacific peoples. COPDX clinical practice
More informationDrug Prior Authorization Guideline NUCALA (mepolizumab)
Drug Prior Authorization Guideline MB9914 Covered Service: Prior Authorization Required: Additional Information: Yes when meets criteria below Yes as shown below Restricted to Pulmonology, Allergy, and
More informationAnyone who smokes and/or has shortness of breath and sputum production could have COPD
COPD DIAGNOSIS AND MANAGEMENT CHECKLIST Anyone who smokes and/or has shortness of breath and sputum production could have COPD Confirm Diagnosis Presence and history of symptoms: Shortness of breath Cough
More informationAsthma ASTHMA. Current Strategies for Asthma and COPD
Current Strategies for Asthma and COPD Talmadge E. King, Jr., M.D. Krevins Distinguished Professor of Medicine Chair, Department of Medicine University of California San Francisco (UCSF) San Francisco,
More informationADULT ASTHMA GUIDE SUMMARY. This summary provides busy health professionals with key guidance for assessing and treating adult asthma.
ADULT ASTHMA GUIDE SUMMARY This summary provides busy health professionals with key guidance for assessing and treating adult asthma. Its source document Asthma and Respiratory Foundation NZ Adult Asthma
More informationImproving the Management of Asthma to Improve Patient Adherence and Outcomes
Improving the Management of Asthma to Improve Patient Adherence and Outcomes Robert Sussman, MD Atlantic Health System Overlook Medical Center Asthma Remains a Serious Health Risk in the US Every day in
More informationAsthma Update I have no professional or personal financial conflicts of interest to disclose.
Asthma Update 2018 Disclosures Jennifer W. McCallister, MD, FACP, FCCP Associate Professor Division of Pulmonary, Critical Care, and Sleep Medicine The Ohio State University Wexner Medical Center I have
More informationAsthma Update Jennifer W. McCallister, MD, FACP, FCCP
Asthma Update 2018 Jennifer W. McCallister, MD, FACP, FCCP Associate Professor Division of Pulmonary, Critical Care, and Sleep Medicine The Ohio State University Wexner Medical Center Disclosures I have
More informationDisclosure and Conflict of Interest 8/15/2017. Pharmacist Objectives. At the conclusion of this program, the pharmacist will be able to:
Digging for GOLD Rebecca Young, PharmD, BCACP, Roosevelt University College of Pharmacy Assistant Professor of Clinical Sciences Practice Site Advocate Medical Group-Nesset Pavilion Disclosure and Conflict
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 informationWhat s new in COPD? Apichart Khanichap MD. Department of Medicine, Faculty of Medicine, Thammasat university
What s new in COPD? Apichart Khanichap MD. Department of Medicine, Faculty of Medicine, Thammasat university Management stable COPD Relieve symptoms Improve exercise tolerance Improve health status Prevent
More informationCOPD: GOLD guidelines Ijlal Babar, MD Medical Director Pulmonary CCM, Pulmonary Hypertension Center SRHS
COPD: GOLD guidelines 2017 Ijlal Babar, MD Medical Director Pulmonary CCM, Pulmonary Hypertension Center SRHS Introduction The Global Initiative for Chronic Obstructive Lung Disease (GOLD) program was
More informationAir Flow Limitation. In most serious respiratory disease, a key feature causing morbidity and functional disruption is air flow imitation.
Asthma Air Flow Limitation In most serious respiratory disease, a key feature causing morbidity and functional disruption is air flow imitation. True whether reversible, asthma and exercise-induced bronchospasm,
More informationThe Acute & Maintenance Treatment of Asthma via Aerosolized Medications
The Acute & Maintenance Treatment of Asthma via Aerosolized Medications Douglas S. Gardenhire, EdD, RRT-NPS, FAARC Associate Professor and Chairman Department of Respiratory Therapy Objectives Define Asthma.
More informationAsthma in the Athlete
Asthma in the Athlete Jorge E. Gomez, MD Associate Professor Texas Children s Hospital Baylor College of Medicine Assist Team Physician UH Understand how we diagnose asthma Objectives Be familiar with
More informationMedical Policy An independent licensee of the Blue Cross Blue Shield Association
Xolair (omalizumab) Page 1 of 15 Medical Policy An independent licensee of the Blue Cross Blue Shield Association Title: Xolair (omalizumab) Prime Therapeutics will review Prior Authorization requests.
More informationWINDY CITY WHEEZE: A PREVENTATIVE APPROACH TO COPD MANAGEMENT
WINDY CITY WHEEZE: A PREVENTATIVE APPROACH TO COPD MANAGEMENT Thursday, October 25, 2018 Sarah Sungurlu DO Assistant Professor Division of Pulmonary and Critical Care Medicine Disclosures I have no actual
More informationClinical and radiographic predictors of GOLD-Unclassified smokers in COPDGene
Clinical and radiographic predictors of GOLD-Unclassified smokers in COPDGene Emily S. Wan, John E. Hokanson, James R. Murphy, Elizabeth A. Regan, Barry J. Make, David A. Lynch, James D. Crapo, Edwin K.
More informationMEDICAL COVERAGE GUIDELINES ORIGINAL EFFECTIVE DATE: 07/05/18 SECTION: DRUGS LAST REVIEW DATE: LAST CRITERIA REVISION DATE: ARCHIVE DATE:
CINQAIR (reslizumab) Non-Discrimination Statement and Multi-Language Interpreter Services information are located at the end of this document. Coverage for services, procedures, medical devices and drugs
More informationAsthma Update A/Prof. John Abisheganaden. Senior Consultant, Dept Of Respiratory & Crit Care Medicine Tan Tock Seng Hospital
Asthma Update - 2013 A/Prof. John Abisheganaden Senior Consultant, Dept Of Respiratory & Crit Care Medicine Tan Tock Seng Hospital Asthma A complex syndrome Multifaceted disease Heterogeneous Genetic and
More informationII: Moderate Worsening airflow limitations Dyspnea on exertion, cough, and sputum production; patient usually seeks medical
Table 3.1. Classification of COPD Severity Stage Pulmonary Function Test Findings Symptoms I: Mild Mild airflow limitations +/ Chronic cough and sputum production; patient unaware of abnormal FEV 1 80%
More informationBlue, Pink and everything in between: an update on COPD. Tara Lohmann MD FRCPC Division of Respirology University of Calgary
Blue, Pink and everything in between: an update on COPD Tara Lohmann MD FRCPC Division of Respirology University of Calgary Disclosures I have eaten lunches provided by many pharmaceutical companies (GSK,
More informationChanging Epidemiology: Quick Facts 9/28/2018. During the year New Treatment Options for COPD: Phenotypes, Endotypes or Treatable Traits?
New Treatment Options for COPD: Phenotypes, Endotypes or Treatable Traits? Conflict of Interest Statement 2018 Speakers Bureau Astra Zeneca Boehringer Ingelheim Genentech Sunovion Ron Balkissoon MD DIH
More informationExercise-Induced Bronchospasm. Michael A Lucia, MD, FCCP Asst Clinical Professor, UNR School of Medicine Sierra Pulmonary & Sleep Institute
Exercise-Induced Bronchospasm Michael A Lucia, MD, FCCP Asst Clinical Professor, UNR School of Medicine Sierra Pulmonary & Sleep Institute EIB Episodic bronchoconstriction with exercise May be an exacerbation
More informationOverview of COPD INTRODUCTION
Overview of COPD INTRODUCTION Chronic obstructive pulmonary disease (COPD) is a common lung disease that affects millions of people, and it is the fourth leading cause of death in the United States. It
More informationAsthma Management in Pregnancy HEATHER HOWE, MD UNIVERSITY OF UTAH PULMONARY DIVISION
Asthma Management in Pregnancy HEATHER HOWE, MD UNIVERSITY OF UTAH PULMONARY DIVISION Asthma Management in Pregnancy Effects of asthma on pregnancy outcomes Effects of pregnancy on asthma control Management
More informationPotential risks of ICS use
Potential risks of ICS use Randomised controlled trial Observational study Systematic review Pneumonia Tuberculosis Bone fracture Skin thinning/easy bruising Cataract Diabetes No effect on fracture risk
More information