Advances in the management of chronic obstructive lung diseases (COPD) David CL Lam Department of Medicine University of Hong Kong October, 2015
|
|
- Cordelia Murphy
- 5 years ago
- Views:
Transcription
1 Advances in the management of chronic obstructive lung diseases (COPD) David CL Lam Department of Medicine University of Hong Kong October, 2015
2 Chronic obstructive pulmonary disease (COPD) COPD in Hong Kong What is COPD? Implications of COPD in exacerbation Non-pharmacological measures Newer treatment strategy
3 1. M Chan-Yeung, Hong Kong Burden of Lung Diseases, Respirology Hong Kong Hospital Authority, Health care burden with COPD in HK The 5th cause of death Common particularly in elderly subjects (9% of elderly subjects age > 70) High disease burden (> 13,000 patients admitted with > 31,000 episodes every year) Overall ~8% medical bed days occupied 25% of unplanned re-admissions
4 Global Strategy for Diagnosis, Management and Prevention of COPD Definition of COPD 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
5 Global Strategy for Diagnosis, Management and Prevention of COPD Mechanisms Underlying Airflow Limitation in COPD Small Airways Disease Airway inflammation Airway fibrosis, luminal plugs Increased airway resistance Parenchymal Destruction Loss of alveolar attachments Decrease of elastic recoil AIRFLOW LIMITATION 2015 Global Initiative for Chronic Obstructive Lung Disease
6 Pulmonary emphysema
7 Very severe airflow limitation
8 Risk (GOLD Classification of Airflow Limitation)) Risk (Exacerbation history) Global Strategy for Diagnosis, Management and Prevention of COPD Combined Assessment of COPD (C) (A) (D) (B) 2 or > 1 leading to hospital admission 1 (not leading to hospital admission) 0 CAT < 10 CAT > 10 Symptoms mmrc 0 1 mmrc > 2 Breathlessness 2015 Global Initiative for Chronic Obstructive Lung Disease
9 If airflow obstruction is irreversible, can the disease course be modified?
10 Global Strategy for Diagnosis, Management and Prevention of COPD Manage Stable COPD: All COPD Patients Avoidance of risk factors - smoking cessation - reduction of indoor pollution - reduction of occupational exposure Influenza and pneumococcal vaccination 2015 Global Initiative for Chronic Obstructive Lung Disease
11 Global Strategy for Diagnosis, Management and Prevention of COPD Therapeutic Options: Key Points Smoking cessation has the greatest capacity to influence the natural history of COPD. Health care providers should encourage all patients who smoke to quit. Pharmacotherapy and nicotine replacement reliably increase long-term smoking abstinence rates. All COPD patients benefit from regular physical activity and should repeatedly be encouraged to remain active Global Initiative for Chronic Obstructive Lung Disease
12 Decline of FEV1 with age and smoking habits It s never too late to quit
13 Is COPD treatable?
14 Global Strategy for Diagnosis, Management and Prevention of COPD Definition and Overview Diagnosis and Assessment Therapeutic Options Manage Stable COPD Manage Exacerbations Manage Comorbidities Updated 2015 Asthma COPD Overlap Syndrome (ACOS) 2015 Global Initiative for Chronic Obstructive Lung Disease
15 Global Strategy for Diagnosis, Management and Prevention of COPD Manage Exacerbations An exacerbation of COPD is: an acute event characterized by a worsening of the patient s respiratory symptoms that is beyond normal day-today variations and leads to a change in medication Global Initiative for Chronic Obstructive Lung Disease
16 Exacerbations and worsening in health status over 3 years 3.0 ANOVA p< SGRQ slope (units/yr) Getting worse faster None in 3 years Infrequent <1.65/yr Frequent >1.65/yr Exacerbation Category Spencer et al. Eur Respir J 2004;23:1-5.
17 TORCH: Exacerbation rate and FEV 1 decline (all treatment arms) Exacerbations per year n=1735 n=1862 n=1306 Rate of decline in FEV 1 (ml/yr) 37% faster 65% faster Adjusted for smoking status, gender, baseline FEV 1, region, BMI, prior exacerbations, treatment, time, time by treatment and covariate by time Celli et al AJRCCM 2008; 178: 332
18 Exacerbation history is most powerful single predictor of exacerbations (independent of GOLD stage) Exacerbations in following year Hurst et al N Engl J Med 2010;363:
19 Increased risk of myocardial infarction and stroke following exacerbation of COPD Annual rate of MI against the annual rate of exacerbation defined as prescription of steroids and antibiotics together. ρ = ; P =.03. Data from 25,857 patients with COPD entered in The Health Improvement Network database over a 2-year period 2.27-fold (95% CI, ; P =.03) increased risk of MI 1 to 5 days after exacerbation (defined by prescription of both steroids and antibiotics) Donaldson et al. CHEST. 2010;137(5): doi: /chest
20 Global Strategy for Diagnosis, Management and Prevention of COPD Manage Exacerbations: Key Points The most common causes of COPD exacerbations are viral upper respiratory tract infections and infection of the tracheobronchial tree. Diagnosis relies exclusively on the clinical presentation of the patient complaining of an acute change of symptoms that is beyond normal day-today variation. The goal of treatment is to minimize the impact of the current exacerbation and to prevent the development of subsequent exacerbations Global Initiative for Chronic Obstructive Lung Disease
21 RESPIRATORY VIRUSES AND EXACERBATIONS Coronavirus Coinfection Up to 60% of COPD exacerbations associated with viruses More often found in sputum than in nasal samples Chlamydia Pneumoniae RSV Serology Adenovirus Parainfluenza Influenza B Rhinovirus Influenza A Seemungal et al Am J Respir Crit Care Med 2001 Seemungal et al ERJ 2000 Rohde Thorax 2003
22 Cumulative Proportion of Patients Without Pneumonia Cumulative Proportion of Patients Without Pneumonia Pneumococcal Vaccination Vaccinated = Control = Vaccinated = Control = Log rank = 6.68 P= Log rank = 3.85 P= (NS) Time (days) Time (days) Alfageme I, et al. Thorax. 2006;61:
23 Consequences of COPD Exacerbations Negative impact on quality of life Impact on symptoms and lung function Accelerated lung function decline EXACERBATIONS Increased economic costs Increased Mortality 2015 Global Initiative for Chronic Obstructive Lung Disease
24 Are medications useful? In what sense?
25 Global Strategy for Diagnosis, Management and Prevention of COPD Therapeutic Options: Key Points Appropriate pharmacologic therapy can reduce COPD symptoms, reduce the frequency and severity of exacerbations, and improve health status and exercise tolerance. None of the existing medications for COPD has been shown conclusively to modify the long-term decline in lung function. Influenza and pneumococcal vaccination should be offered depending on local guidelines Global Initiative for Chronic Obstructive Lung Disease
26 Global Strategy for Diagnosis, Management and Prevention of COPD Therapeutic Options: Bronchodilators Long-acting inhaled bronchodilators are convenient and more effective for symptom relief than short-acting bronchodilators. Long-acting inhaled bronchodilators reduce exacerbations and related hospitalizations and improve symptoms and health status. Combining bronchodilators of different pharmacological classes may improve efficacy and decrease the risk of side effects compared to increasing the dose of a single bronchodilator Global Initiative for Chronic Obstructive Lung Disease
27 Accuhalers Handihaler Many others LAMA + LABA = LAMA/LABA
28 SABA: short-acting beta2-agonist (salbutamol, albuterol) SAMA: short-acting muscarinic antagonist (ipratropium) LABA: long-acting beta2-agonist (indacaterol, vilanterol, salmeterol, formoterol) LAMA: long-acting muscarinic antagonist (tiotropium, glycopyrronium) ICS: inhaled corticosteroids PDE4I: phosphodiesterase-4 inhibitor (Roflumilast)
29
30
31 Global Strategy for Diagnosis, Management and Prevention of COPD Therapeutic Options: Combination Therapy An inhaled corticosteroid combined with a long-acting beta 2 -agonist is more effective than the individual components in improving lung function and health status and reducing exacerbations in moderate to very severe COPD. Combination therapy is associated with an increased risk of pneumonia. Addition of a long-acting beta 2 -agonist/inhaled glucorticosteroid combination to an anticholinergic (tiotropium) appears to provide additional benefits Global Initiative for Chronic Obstructive Lung Disease
32
33
34
35 Inhalers therapy LABA/LAMA/ICS Some controversies? No evidence of cataracts, fractures or accelerated loss of BMD with ICS Dry mouth with LAMA, hoarse voice with ICS in low numbers No evidence of cardiac risk with beta-agonist Anticholinergic in mist format now found to be safe Use of ICS with increased pneumonia? But lower hospital mortality if on ICS
36 Can we do better?
37 Newer treatment options Treatment for co-morbidities beta blockers can be used unless there is a clear asthmatic component (ACOS) Combinations of bronchodilators and/or ICS once daily PDE4 inhibition roflumilast
38 COPD comorbidities Coronary artery diseases Congestive heart failure Atrial fibrillation Hypertension Diabetes Lung cancer Pneumonia Osteoporosis Anxiety Depression
39 Exacerbations * per patient per year M2-111 and M2-112: Roflumilast reduces exacerbation rates 0.8 Study M2-111 Study M2-112 Post-hoc pooled analysis 14.0% (Cl 29;5) p= % (Cl 30;2) p= % (Cl 25; 2) p= Placebo Roflumilast n= *Moderate or severe exacerbations treated with systemic steroids or leading to hospitalization or death Rennard SI, Calverley PM, Goehring UM, et al. Respir Res 2011;12:18.
40 Roflumilast efficacy is greatest in patients with chronic cough and sputum A post-hoc, pooled analysis of studies M2-111 and M2-112 examined the efficacy of roflumilast in exacerbation reduction in patient sub-groups Overall Current smokers Former smokers ICS: yes ICS: no Anticholinergic: yes Anticholinergic: no Very severe COPD Severe COPD Emphysema Chronic bronchitis ± emphysema Chronic bronchitis ± emphysema + ICS Chronic bronchitis ± emphysema ICS Cough score 1 Cough score <1 Sputum score 1 Sputum score <1 ICS = inhaled corticosteroid Rennard SI, Calverley PM, Goehring UM, et al. Respir Res 2011;12:18. Favours roflumilast Favours placebo
41 Patients (%) Roflumilast can shift patients from the frequent to the more stable infrequent exacerbator state M2-124/125 pooled post-hoc analysis Frequent exacerbator subgroup The risk of remaining a frequent exacerbator was 20% lower in the roflumilast group 20% risk ratio=0.799; p= Infrequent exacerbator subgroup The risk of becoming a frequent exacerbator was 23% lower in the roflumilast group 23% risk ratio=0.768; p= Exacerbations occurring during the 12 months of the study *As-needed SABA and stable doses of LABAs/SAMAs were permitted. Concomitant ICS or LAMA use was not permitted. Placebo* Roflumilast* 1. Adapted from Wedzicha JA, Rabe KF, Martinez FJ, et al. Chest 2012 doi: /chest
42 Roflumilast was generally well tolerated in clinical studies Data were pooled from four 1-year placebo-controlled trials and four 6-month trials for evaluation of adverse reactions Adverse reactions that occurred with a frequency >2% of patients tested Adverse reaction Roflumilast (N=4,438) Placebo (N=4,192) Diarrhoea, % (n) 9.5 (420) 2.7 (113) Weight loss, % (n) 7.5 (331) 2.1 (89) Nausea, % (n) 4.7 (209) 1.4 (60) Back pain, % (n) 3.2 (142) 2.2 (92) Influenza, % (n) 2.8 (124) 2.7 (112) Insomnia, % (n) 2.4 (105) 1.0 (41) Decreased appetite, % (n) 2.1 (91) 0.4 (15) 1. Michalski JM, Golden G, Ikari J and Rennard SI. Clin Pharm Ther 2012;91:
43
44
45 Dual bronchodilatation: LABA + LAMA as a maintenance bronchodilator treatment to relieve symptoms in adult patients with chronic obstructive pulmonary disease (COPD).
46
47
48 Once daily dual bronchodilation LANTERN Study - To evaluate the efficacy and safety of IND/GLY compared with SFC NS Zhong, et al. Int J COPD, 2015
49 Once daily dual bronchodilation LANTERN Study - To evaluate the efficacy and safety of IND/GLY compared with SFC IND/GLY significantly prolonged the time to first moderate or severe exacerbation by 31% compared with SFC 49 Zhong et al. Int J COPD, 2015
50 Once daily dual bronchodilation LANTERN Study - To evaluate the efficacy and safety of IND/GLY compared with SFC Adverse events, serious adverse events, deaths and discontinuations was similar across the treatment groups The incidence of pneumonia was 3-fold lower with IND/GLY compared with SFC Pneumonia is a major risk associated with SFC and cause for hospitalization IND/GLY n=372 SFC n=369 Over all AEs 149 (40.1) 175 (47.4) Any AE events in 1.5% of any group COPD worsening a 75 (20.2) 97 (26.3) Nasopharyngitis 30 (8.1) 45 (12.2) Upper respiratory tract infection 13 (3.5) 26 (7.0) Bronchitis 7 (1.9) 4 (1.1) Pneumonia 3 (0.8) 10 (2.7) Dyspnea 2 (0.5) 6 (1.6) Oropharyngeal pain 2 (0.5) 6 (1.6) AEs leading to discontinuation 12 (3.2) 17 (4.6) COPD worsening 3 (0.8) 7 (1.9) Any SAE 20 (5.4) 35 (9.5) COPD 6 (1.6) 17(4.6) SAEs leading to discontinuation 9 (2.4) 11 (3.0) Non-SAE(s) leading to discontinuation 3 (0.8) 7 (1.9) Deaths 2 (0.5) 0 50 Zhong et al. Int J COPD, 2015
51 Non-invasive ventilation (NIV) for COPD NIV has assumed an important role in the management of acute respiratory failure (ARF) Evidence is strong to support its use in ARF in patients with COPD exacerbations, acute cardiac pulmonary edema and obesity hypoventilation. Appropriate patient selection and proper application of NIV is paramount in its success in improving patient outcomes and the efficiency of care.
52 Summary: Chronic obstructive pulmonary disease (COPD) Identification and reduction of exposure to risk factors. Individualized assessment of respiratory symptoms, airflow limitation, and risk of COPD exacerbations. COPD exacerbations are to be prevented Non-pharmacological measures, especially smoking cessation, vaccination and pulmonary rehabilitation training, bear significant impact on COPD management and prevention of exacerbation Long-acting bronchodilators +/- ICS to reduce symptoms, reduce frequency and severity of exacerbations, and improve health status and exercise tolerance.
53 Thank you
54 COPD Assessment Test (CAT) X 1 X 1 X 2 X X X X X Scoring range 0-40 Total score
Turning 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 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 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: 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 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 informationPharmacotherapy for COPD
10/3/2017 Topics to be covered Pharmacotherapy for chronic treatment Pharmacotherapy for COPD Dr. W C Yu 3rd September 2017 Commonly used drugs Guidelines for their use Inhaled corticosteroids (ICS) in
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 informationTORCH: Salmeterol and Fluticasone Propionate and Survival in COPD
TORCH: and Propionate and Survival in COPD April 19, 2007 Justin Lee Pharmacy Resident University Health Network Outline Overview of COPD Pathophysiology Pharmacological Treatment Overview of the TORCH
More informationManagement of Acute Exacerbations of COPD
MiCMRC Educational Webinar Management of Acute Exacerbations of COPD August 22, 2018 MiCMRC Educational Webinar Management of Acute Exacerbations of COPD Expert Presenter: Catherine A. Meldrum PhD RN MS
More informationCOPD: Preventable and Treatable. Lecture Outline. Diagnosis of COPD. COPD: Defining Terms
COPD: Preventable and Treatable Christopher H. Fanta, M.D. Partners Asthma Center Pulmonary and Critical Care Division Brigham and Women s Hospital Harvard Medical School Lecture Outline I. Diagnosis and
More informationTreatment Responses. Ronald Dahl, Aarhus University Hospital, Denmark
Asthma and COPD: Are They a Spectrum Treatment Responses Ronald Dahl, Aarhus University Hospital, Denmark Pharmacological Treatments Bronchodilators Inhaled short-acting β -Agonist (rescue) Inhaled short-acting
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 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 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 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 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 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 informationรศ. นพ. ว ชรา บ ญสว สด M.D., Ph.D. ภาคว ชาอาย รศาสตร คณะแพทยศาสตร มหาว ทยาล ยขอนแก น
รศ. นพ. ว ชรา บ ญสว สด M.D., Ph.D. ภาคว ชาอาย รศาสตร คณะแพทยศาสตร มหาว ทยาล ยขอนแก น COPD Guideline Changing concept in COPD management Evidences that we can offer COPD patients better life COPD Guidelines
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 informationCOPD: Treatment Update Property of Presenter. Not for Reproduction. Barry Make, MD Professor of Medicine National Jewish Health
COPD: Treatment Update Barry Make, MD Professor of Medicine National Jewish Health Disclosures Advisory board, consultant, multi-center trial, research funding, Data Safety Monitoring Board (DSMB), or
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 informationSupplementary appendix
Supplementary appendix This appendix formed part of the original submission and has been peer reviewed. We post it as supplied by the authors. Supplement to: Calverley P M A, Anzueto A R, Carter K, et
More informationSurveillance report Published: 6 April 2016 nice.org.uk. NICE All rights reserved.
Surveillance report 2016 Chronic obstructive pulmonary disease in over 16s: diagnosis and management (2010) NICE guideline CG101 Surveillance report Published: 6 April 2016 nice.org.uk NICE 2016. All rights
More informationCOPD Update. Muhammad Talha Khan MD. COPD Exacerbations. COPD Clinical Importance. COPD Pathophysiology. Overview/Objectives
Overview/Objectives COPD Update Muhammad Talha Khan MD Pulmonologist St Croix Regional Medical Center, St Croix Falls, WI. Overview of COPD and disease impact Classification of COPD Severity Treatment
More informationAECOPD: Management and Prevention
Neil MacIntyre MD Duke University Medical Center Durham NC Professor P.J. Barnes, MD, National Heart and Lung Institute, London UK Professor Peter J. Barnes, MD National Heart and Lung Institute, London
More informationIf you require this document in another format such as Braille, large print, audio or another language please contact the Trusts Communications Team
MANAGEMENT OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) IN ADULTS Summary statement: How does the document support patient care? Staff/stakeholders involved in development: Job titles only Division:
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 informationRoflumilast (Daxas) for chronic obstructive pulmonary disease
Roflumilast (Daxas) for chronic obstructive pulmonary disease August 2009 This technology summary is based on information available at the time of research and a limited literature search. It is not intended
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 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 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 informationAdvancing COPD treatment strategies with evidencebased. 17:15 19:15 Monday 11 September 2017 ERS 2017, Milan, Italy
Advancing COPD treatment strategies with evidencebased approaches 17:15 19:15 Monday 11 September 2017 ERS 2017, Milan, Italy Increasing understanding of COPD and the effect on guideline evolution. GOLD
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 informationCurriculum Vitae. Head of Public Wing HCU - RSCM. Head of ICU Sari Asih Ciledug Hospital
Curriculum Vitae Name : Dr. Ceva W. Pitoyo,SpPD,K-P,KIC,FINASIM POB / DOB : Jakarta, March 8th 1968 Education : o General Practitioner : FKUI 1993 o Internist : FKUI 2002 o Pulmonology Consultant : PAPDI-UI
More informationObjectives. Advances in Managing COPD Patients
4:45 5:30pm Advances in Managing Patients SPEAKER Nicola Hanania, MD, FCCP, FRCP, FACP Presenter Disclosure Information The following relationships exist related to this presentation: Nicola Hanania, MD,
More informationChoosing an inhaler for COPD made simple. Dr Simon Hart Castle Hill Hospital
Choosing an inhaler for COPD made simple Dr Simon Hart Castle Hill Hospital 1 Declaration of interests I have received speaker fees, sponsorship to attend conferences, and funding for research from companies
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 informationGlobal 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 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 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 informationroflumilast 500 microgram tablets (Daxas ) SMC No. (635/10) Nycomed Ltd
roflumilast 500 microgram tablets (Daxas ) SMC No. (635/10) Nycomed Ltd 06 August 2010 (Issued 10 September 2010) The Scottish Medicines Consortium (SMC) has completed its assessment of the above product
More informationRe-Submission. roflumilast, 500 microgram, film-coated tablet (Daxas ) SMC No 635/10 AstraZeneca UK Ltd. Published 11 September
Re-Submission roflumilast, 500 microgram, film-coated tablet (Daxas ) SMC No 635/10 AstraZeneca UK Ltd 4 August 2017 The Scottish Medicines Consortium (SMC) has completed its assessment of the above product
More informationCOPD and Asthma Update. April 29 th, 2017 Rachel M Taliercio, DO Staff, Respiratory Institute
COPD and Asthma Update April 29 th, 2017 Rachel M Taliercio, DO Staff, Respiratory Institute What we ll be talking about COPD: diagnosis, management of stable COPD, COPD exacerbations Asthma: diagnosis,
More informationRoflumilast: Οι κλινικές μελέτες
Roflumilast: Οι κλινικές μελέτες Επαμεινώνδας Ν. Κοσμάς Δ/ντής Πνευμονολογικού Τμήματος Νοσοκομείου Metropolitan PDE4 PLAYS AN IMPORTANT ROLE IN INFLAMMATION PDE4 inhibition P P P PDE4 P Adapted from Rabe
More informationCOPD EXACERBATIONS AND HOSPITAL ADMISSIONS HOW CAN WE PREVENT THEM? Wisia Wedzicha National Heart and Lung Institute, Imperial College London, UK
COPD EXACERBATIONS AND HOSPITAL ADMISSIONS HOW CAN WE PREVENT THEM? Wisia Wedzicha National Heart and Lung Institute, Imperial College London, UK Presenter Disclosures Wisia Wedzicha All disclosures prior
More informationChronic Obstructive Pulmonary Disease: What s New in Therapeutic Management?
Chronic Obstructive Pulmonary Disease: What s New in Therapeutic Management? Sabrina Sherwood, PharmD PGY2 Internal Medicine Resident University of Utah Health September 29, 2018 Disclosures Relevant disclosures
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 informationCOPD Update. Plus New and Improved Products for Inhaled Therapy. Catherine Bourg Rebitch, PharmD, BCACP Clinical Associate Professor
COPD Update Plus New and Improved Products for Inhaled Therapy Catherine Bourg Rebitch, PharmD, BCACP Clinical Associate Professor Disclosure The presenter has nothing to disclose concerning possible financial
More informationDisclosure Statement. Epidemiological Data
EVALUATION OF THE MEDICATION UTILIZATION OF COPD PATIENTS AT THE MIAMI VA HEALTHCARE SYSTEM Simone Edgerton, PharmD. PGY 1 Pharmacy Resident Miami VA Healthcare System Miami, Florida Simone.edgerton2@va.gov
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 information2017 GOLD Report. Is it worth its weight in GOLD??? CSHP-NB Fall Education Day September 30, 2017
2017 GOLD Report Is it worth its weight in GOLD??? CSHP-NB Fall Education Day September 30, 2017 Lauren Munro; BSc(Pharm) Amanda Burns; BSc(Pharm) Pharmacy Residents The Moncton Hospital Objectives Explain
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 informationCARE OF THE ADULT COPD PATIENT
CARE OF THE ADULT COPD PATIENT Target Audience: The target audience for this clinical guideline is all MultiCare providers and staff including those associated with our Clinically Integrated Network. The
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 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 informationCOPD Management in LTC: Presented By: Jessica Denney RRT
COPD Management in LTC: Presented By: Jessica Denney RRT Sponsored by Z & D Medical Services, Diamond Sponsor Seizing Opportunities to Provide Individualized Treatment and Device Selection for your COPD
More informationTo describe the impact of COPD exacerbations and the importance of the frequent exacerbator phenotype.
Educational aims To describe the impact of COPD exacerbations and the importance of the frequent exacerbator phenotype. To describe the spectrum of pharmacological and non-pharmacological interventions
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 informationBlood Eosinophils and Response to Maintenance COPD Treatment: Data from the FLAME Trial. Online Data Supplement
Blood Eosinophils and Response to Maintenance COPD Treatment: Data from the FLAME Trial Nicolas Roche, Kenneth R. Chapman, Claus F. Vogelmeier, Felix JF Herth, Chau Thach, Robert Fogel, Petter Olsson,
More informationCOPD UPDATE ıdr Shitrit David ıhead of the Pulmonary Department ımeir Medical Center
COPD UPDATE 2012 ıdr Shitrit David ıhead of the Pulmonary Department ımeir Medical Center Definition of COPD COPD is a preventable and treatable disease with some significant extra pulmonary effects that
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 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 informationExacerbations of COPD. Dr J Cullen
Exacerbations of COPD Dr J Cullen Definition An AECOPD is a sustained worsening of the patient s clinical condition from their stable state that is beyond their usual day-to-day variation is acute in onset
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 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 informationTreatment. Assessing the outcome of interventions Traditionally, the effects of interventions have been assessed by measuring changes in the FEV 1
58 COPD 59 The treatment of COPD includes drug therapy, surgery, exercise and counselling/psychological support. When managing COPD patients, it is particularly important to evaluate the social and family
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 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 informationChronic Obstructive Pulmonary Disease
Chronic Obstructive Pulmonary Disease CareOregon Pharmacy Abridged sample of presentation content Home Equipment Pathophysiology Exacerbations Guidelines Lifestyle Modification Medication Management Sample
More informationChronic Obstructive Pulmonary Disease (COPD) Treatment Guidelines
Chronic Obstructive Pulmonary Disease (COPD) Treatment Guidelines Where appropriate the following should be offered before commencing inhaled treatment: Offer treatment and support to stop smoking. Smoking
More informationCOPD. Salah Zeineldine, MD FACP Pulmonary & Critical Care Medicine American University of Beirut Lebanese Society of Family Medicine 2012
COPD Salah Zeineldine, MD FACP Pulmonary & Critical Care Medicine American University of Beirut Lebanese Society of Family Medicine 2012 Attitude It is a disease on which a good deal of wholly, unmerited
More informationCHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) TREATMENT GUIDELINES
CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) TREATMENT GUIDELINES Document Description Document Type Service Application Version Guidelines All healthcare professionals(hcps) caring for patients with asthma
More informationaclidinium 322 micrograms inhalation powder (Eklira Genuair ) SMC No. (810/12) Almirall S.A.
aclidinium 322 micrograms inhalation powder (Eklira Genuair ) SMC No. (810/12) Almirall S.A. 05 October 2012 The Scottish Medicines Consortium (SMC) has completed its assessment of the above product and
More informationCOPD as a comorbidity of heart failure in elderly patients
COPD as a comorbidity of heart failure in elderly patients Professor Mitja Lainscak, MD, PhD, FESC, FHFA Departments of Cardiology and Research&Education, General Hospital Celje Faculty of Medicine, University
More informationWhat is COPD? COPD Pharmacotherapy. COPD Mortality Is Increasing
COPD Pharmacotherapy Chronic Bronchitis What is COPD? 75% 17.5% Emphysema Laura C. Feemster, MD, MS Assistant Professor University of Washington Division of Pulmonary & Critical Care April 23,2015 COPD
More informationThe impacts of cognitive impairment on acute exacerbations of chronic obstructive pulmonary disease
The impacts of cognitive impairment on acute exacerbations of chronic obstructive pulmonary disease Dr. Lo Iek Long Department of Respiratory Medicine C.H.C.S.J. Chronic Obstructive Pulmonary Disease (COPD)
More informationA Study of Prescription Pattern in the Management of COPD in a Tertiary Care Hospital.
DOI: 10.21276/aimdr.2016.2.3.39 Original Article ISSN (O):2395-2822; ISSN (P):2395-2814 A Study of Prescription Pattern in the Management of COPD in a Tertiary Care Hospital. Mazher Maqusood 1, Farhan
More informationManagement of Acute Exacerbations
15 Management of Acute Exacerbations Cenk Kirakli Izmir Dr. Suat Seren Chest Diseases and Surgery Training Hospital Turkey 1. Introduction American Thoracic Society (ATS) and European Respiratory Society
More informationUPDATE IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE
UPDATE IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE Radhika Shah, MD Erlanger Health System University of Tennessee College of Medicine Chattanooga Respiratory, Critical Care, and Sleep medicine No disclosures
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 informationAn Update in COPD John Hurst PhD FRCP
An Update in COPD John Hurst PhD FRCP Reader in Respiratory Medicine / Honorary Consultant University College London / Royal Free London NHS Foundation Trust j.hurst@ucl.ac.uk What s new in COPD papers
More information7.2 Part VI.2 Elements for a Public Summary
7.2 Part VI.2 Elements for a Public Summary 7.2.1 Part VI.2.1 Overview of disease epidemiology Chronic obstructive pulmonary disease (COPD) is characterized by persistent airflow limitation that is usually
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 informationThree s Company - The role of triple therapy in chronic obstructive pulmonary
Three s Company - The role of triple therapy in chronic obstructive pulmonary disease (COPD) October 26 th, 2018 Zahava Picado, PharmD PGY1 Pharmacy Resident Central Texas Veterans Healthcare System Zahava.Picado@va.gov
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 informationCOPD: From Hospital to Home October 5, 2015 Derek Linderman, MD Associate Professor COPD Center Pulmonary Nodule Clinic
COPD: From Hospital to Home October 5, 2015 Derek Linderman, MD Associate Professor COPD Center Pulmonary Nodule Clinic Learning Objectives Know the adverse effects of COPD exacerbations Know mainstays
More informationMedicines Management of Chronic Obstructive Pulmonary Disease (COPD)
Medicines Management of Chronic Obstructive Pulmonary Disease (COPD) (Chronic & Acute) Guidelines for Primary Care Guideline Authors: Shaneez Dhanji (Wandsworth CCG) Samantha Prigmore (St George s Hospital)
More informationNuovi farmaci in sviluppo per la BPCO
PNEUMOLOGIA 2018 MILANO, 14 16 GIUGNO 2018 CENTRO CONGRESSI PALAZZO DELLE STELLINE Nuovi farmaci in sviluppo per la BPCO Leonardo M. Fabbri, MD, FERS Professor of Respiratory and Internal Medicine, University
More informationCHRONIC OBSTRUCTIVE PULMONARY DISEASE
CHRONIC OBSTRUCTIVE PULMONARY DISEASE DEFINITION Chronic obstructive pulmonary disease (COPD) is a common preventable and treatable disease characterized by airflow limitation that is usually progressive
More informationOptimum COPD Care in 2010 Why Not Now? David E. Taylor, M.D. Pulmonary/Critical Care Ochnser Medical Center
Optimum COPD Care in 2010 Why Not Now? David E. Taylor, M.D. Pulmonary/Critical Care Ochnser Medical Center dtaylor@ochsner.org Observations from Yesterday EPIC is epidemic No EMR No Way!!! Accountability/Benchmarking
More informationCHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) MOUSTAPHA ABIDALI, DO CRITICAL CARE FELLOW UNIVERSITY OF ARIZONA- PHOENIX
CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) MOUSTAPHA ABIDALI, DO CRITICAL CARE FELLOW UNIVERSITY OF ARIZONA- PHOENIX COPD OUTLINE Definition and Overview Pathophysiology Diagnosis and Assessment Therapeutic
More informationThe study listed may include approved and non-approved uses, formulations or treatment regimens. The results reported in any single study may not
The study listed may include approved and non-approved uses, formulations or treatment regimens. The results reported in any single study may not reflect the overall results obtained on studies of a product.
More informationCOPD. Dr.O.Paknejad Pulmonologist Shariati Hospital TUMS
IN THE NAME OF GOD COPD Dr.O.Paknejad Pulmonologist Shariati Hospital TUMS Definition of COPD* COPD is a preventable and treatable chronic lung disease characterized by airflow limitation that is not fully
More informationDecramer 2014 a &b [21]
Buhl 2015 [19] Celli 2014 [20] Decramer 2014 a &b [21] D Urzo 2014 [22] Maleki-Yazdi 2014 [23] Inclusion criteria: Diagnosis of chronic obstructive pulmonary disease; 40 years of age or older; Relatively
More informationglycopyrronium 44 micrograms hard capsules of inhalation powder (Seebri Breezhaler ) SMC No. (829/12) Novartis Pharmaceuticals Ltd.
glycopyrronium 44 micrograms hard capsules of inhalation powder (Seebri Breezhaler ) SMC No. (829/12) Novartis Pharmaceuticals Ltd. 07 December 2012 The Scottish Medicines Consortium (SMC) has completed
More informationCOPD exacerbation. Dr. med. Frank Rassouli
Definition according to GOLD report: - «An acute event - characterized by a worsening of the patients respiratory symptoms - that is beyond normal day-to-day variations - and leads to a change in medication»
More informationAddress Comorbidities
Greater Manchester COPD Management Plan Non-pharmacological management for ALL patients Smoking Cessation Annual Flu Vaccination Pulmonary Rehabilitation Increase daily activity Inhaler Technique Measure
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 informationPresented by UIC College of Nursing
Presented by UIC College of Nursing Describe COPD. Identify red flags for a COPD exacerbation. Identify COPD triggers or risk factors. Differentiate between long-acting inhalers and emergency use inhalers.
More informationChronic Obstructive Pulmonary Disease 1/18/2018
Presented by UIC College of Nursing Describe COPD. Identify red flags for a COPD exacerbation. Identify COPD triggers or risk factors. Differentiate between long acting inhalers and emergency use inhalers.
More information