Prescribing guidelines: Management of COPD in Primary Care
|
|
- Lorin Casey
- 5 years ago
- Views:
Transcription
1 Prescribing guidelines: Management of COPD in Primary Care Establish diagnosis of COPD in patients 35 years with appropriate symptoms with history, examination and spirometry (FEV1/FVC ratio < 70%) Establish severity of disease by FEV 1 as % predicted Management of RISK FACTORS plus EDUCATION plus IMMUNISATION Smoking cessation, Lifestyle intervention, Diet/Exercise, Influenza vaccine (annual), Pneumococcal vaccine, Psychological issues. Pulmonary rehabilitation if functionally disabled- Consider referral to pulmonary rehabilitation if MRC score 3 Abbreviations: SABA- Short acting β 2 agonist SAMA- Short acting muscarinic antagonist LABA- Long acting β agonist LAMA- Long acting muscarinic agent ICS- Inhaled corticosteroid PRN- when required STEP 1 Breathlessness and / Exercise limitation Start SABA Assess response in 4 weeks and review before proceeding to next option If no benefit or persistent symptoms consider adding SAMA Salbutamol - Two puffs when required Terbutaline - one puff when required MDI via volumatic spacer SAMA This should only be considered if there is intolerance to SABA Intolerance refers to an inability to tolerate the adverse effects of a medication, generally at therapeutic or subtherapeutic doses Ipratropium CFC-free aerosol Two puffs four times daily STEP 2 Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) Available from: SYMPTOMATIC RELIEF OF PERSISTENT BREATHLESSNESS IN MODERATE TO VERY SEVERE COPD (FEV1 < 80%) REDUCING EXACERBATIONS IN MODERATE TO VERY SEVERE COPD (FEV1 < 80%) With persistent breathlessness Consider adding either LABA(OPTION 1) or LAMA (OPTION 2) With 2 exacerbations in last 12months Start: ICS + LABA Option 1. Add LABA Continue SABA Assess response in 4weeks and review. 1. If there is optimal benefits on LABA continue and no need to add other regimen 2. If no benefit - Discontinue the use of LABA and consider option 2(LAMA) 3. If there is some benefit on LABA but not full symptomatic improvement, consider adding a LAMA to LABA Option 2. Add LAMA Continue SABA (Stop SAMA) Assess response in 4weeks and review. 1. If there is optimal benefits on LAMA continue and no need to add other regimen 2. If no benefit - Discontinue the use of LAMA and consider option 1(LABA) 3. If there is some benefit on LAMA but not full symptomatic improvement, consider adding a LABA (Consider LABA+ LAMA if ICS declined or not tolerated) Clinicians are reminded that black triangle drugs ( ) are relatively new and intensively monitored. Report adverse reactions and suspected reactions via the Yellow Card Scheme by healthcare professionals and members of the public Use of ICS in COPD should be in combination with a LABA Remember to stop single device LABA in patient starting on ICS+LABA combination Clinicians are reminded that black triangle drugs ( ) are relatively new and intensively monitored. Report adverse reactions and suspected reactions via the Yellow Card Scheme by healthcare professionals and members of the public LABA LAMA ICS+LABA combination Formoterol *Easyhaler Formoterol 12micrograms twice daily (maximum per dose 24micrograms); for symptom relief additional doses may be taken to maximum daily dose; maximum 48microgram per day Tiotropium handihaler Breath actuated dry capsule; use one capsule in handihaler once daily Different brands available; consider using brand recommended on script switch Beclometasone with Formoterol 100/6microgram Fostair MDI 100/6mcg via volumatic spacer Two inhalation twice a day Fostair Nexthaler 100/6 Two inhalation twice a day Fluticasone furoate/vilanterol (Relvar Ellipta) 92/22mcg One puff daily Salmeterol Available as CFC-free aerosol 25micrograms per actuation; Two puffs twice a day. *Inhalation of powder 50microgram per dose; One blister twice a day Different brands available; prescribe by a brand name. Consider using brand recommended on script switch Umeclidium (Incruse Ellipta ) Consider in new patients By inhalation of powder, each 65microgram of umeclidium bromide deliver 55microgram of umeclidium One inhalation dose once daily Budesonide with Formoterol DuoResp spiromax 160/4.5 DuoResp spiromax 320/9 Symbicort 200/6 turbohaler/mdi Symbicort 400/12 turbohaler Two puffs twice daily One puff twice daily Two puffs twice daily One puff twice daily 1
2 In patients requiring both LABA and LAMA, once response is satisfactory: May consider the option of a LABA+LAMA combination in a single device If exacerbation persists, consider Triple therapy with LABA/ICS plus LAMA plus PRN SABA (stop SAMA) If patient is on a combination inhaler for LABA+ LAMA., stop this. Start on LAMA and add an ICS+LABA combination Remember use of ICS in COPD should be in combination with a LABA Umeclidium /Vilanterol ( Anoro Ellipta ) 55/22microgram One puff daily Aclidinium/Formoterol ( Duaklir Genuair )12/340 micrograms One puff twice a day Fostair / Incruse Ellipta Relvar / Incruse Ellipta Fostair / Tiotropium ENSURE ALL INHALERS ARE PRESCRIBED BY BRAND NAMES If still symptomatic refer to specialist SAMA Short Acting β 2 Agonists SAMA- Short acting muscarinic antagonists Salbutamol Terbutaline Ipratropium LABA: Long Acting β 2 agonists LAMA: Long Acting Muscarinic Antagonist LABA+LAMA Combination Tiotropium (Braltus zonda ) Incruse Ellipta Salmeterol(Soltel ) Formoterol Easyhaler Anoro Ellipta Duaklir Genuair Inhaled Corticosteroids (ICS) in a combination inhaler (I CS+ LABA) Fostair Relvar Ellipta 92/22 DuoResp Symbicort 2
3 Value pyramid for COPD (The London Respiratory Team 2013) QALY= quality-adjusted life year It is considered that interventions costing the NHS less than 20,000 per QALY gained is cost effective while cost between 20,000 and 30,000 per QALY gained may also be deemed cost effective. Triple therapy in COPD (i.e. an ICS plus LAMA plus LABA) cost between 7,000 and 187,000 (upper limit) which is well above NICE threshold of 21,000 per QALY for a treatment to be regarded as cost effective. This highlight the importance for Non-drug interventions and lifestyle advise such as stopping smoking, flu vaccination and pulmonary rehabilitation as these interventions are more cost effective than COPD drug treatments. 3
4 Assess each new treatment step four weeks after initiation Check inhaler technique Consider alternative diagnosis Has the treatment made a difference to you? Is your breathing easier in any way? Can you do somethings that you could do before or do the same things faster? Are you less breathless than before when doing these things? Record MRC scale Referral to Specialist Community Service( Louise House ) /a specialist When there is : Diagnosis uncertainty Uncontrolled COPD Onset of cor pulmonale Assessment of surgery: bullous lung disease, lung reduction surgery Rapid decline in FEV 1 Age <40 or FH of alpha 1 antitrypsin deficiency Frequent infection If no benefit STOP treatment and consider alternative. Try to prescribe the same type of device for each type of drug Nebulisers Pulmonary Rehabilitation: Consider referral to pulmonary rehabilitation if MRC score is 3 Regular nebulisers are rarely recommended and should only be initiated following consultant advice Consider high dose bronchodilator via a large volume spacer Lifestyle advice: Smoking cessation- promote at every opportunity Dietary advice- if BMI < 20 OR >30 Exercise- promote gentle exercise Self-Management Consider written self -management plan for all patients. Consider rescue pack for appropriate patients. Prescribe antibiotics in line with antimicrobial guidance Immunisation: Influenza annually Pneumococcal as per green book Anxiety and Depression: Screen for anxiety and depression using the PHQ-9 / HADS score Oxygen therapy: If SPO 2 <92% ( at rest and stable) refer to Home Oxygen Service and Review(HOSAR) Respiratory and COPD Services, Louise House Shrewsbury Tel contact: Chronic Productive Cough: Consider trial of carbocisteine. If capsules are not tolerated consider using 750mg/sachet rather than liquid syrup (One sachet TDS then reduce to One sachet BD). This should be stopped if there is no benefit after a 4-week trial. 4
5 HOW TO USE A VOLUMATIC SPACER DEVICE Single Breath Technique 1. Remove the cap. 2. Shake the inhaler and insert into the device. 3. Place the mouthpiece in the mouth. 4. Press (activate) the canister once to release a dose of the drug. 5. Take a deep, slow breath in. 6. Hold the breath for about 10 seconds, then breathe out through the mouthpiece. 7. Remove the device from the mouth. For a further dose wait a few seconds before shaking the spacer and MDI together 2 or 3times. Then repeat steps 3-7. ALWAYS DEMONSTRATE TO THE PATIENT HOW TO USE THE SPACER DEVICE. HOW TO USE A VOLUMATIC SPACER DEVICE Multiple Breath Technique 1. Remove the cap. 2. Shake the inhaler and insert into the device. 3. Place the mouthpiece in the mouth. 4. Make sure the mouthpiece valve can be activated by breathing in and out slowly and gently. (The device will make a clicking sound as the valve opens and closes). 5. Press (activate) the canister once and breathe in and out 5 or 6 times (tidal breathing). 6. Remove the device from the mouth. For a further dose wait a few seconds before shaking the spacer and MDI together 2 or 3times. Then repeat steps 5-6. ALWAYS DEMONSTRATE TO THE PATIENT HOW TO USE THE SPACER DEVICE. 5
CHRONIC 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 informationAlgorithm for the use of inhaled therapies in COPD Version 2 May 2017
Algorithm for the use of inhaled therapies in COPD This document has been revised by the Berkshire West Respiratory Network to support clinicians in selecting the most appropriate, cost effective treatments
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 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 informationWirral COPD Prescribing Guidelines
Wirral COPD Prescribing Guidelines (To be read in conjunction with the Wirral COPD Supplementary Information) STEP 1: Assess symptoms COPD Assessment Test (CAT) [Link for CAT-test Online] is a patient-completed
More informationAlgorithm for the use of inhaled therapies in COPD
Berkshire West Integrated Care System Representing Berkshire West Clinical Commisioning Group Royal Berkshire NHS Foundation Trust Berkshire Healthcare NHS Foundation Trust Berkshire West Primary Care
More informationCo. Durham & Darlington Respiratory Network COPD Treatment Guide
Co. Durham & Darlington Respiratory Network COPD Treatment Guide Age > 35, Productive cough, Breathless, Smoking Hx Spirometry (post-bronchodilator) COPD Advice Intensive smoking cessation support Vaccination
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 informationGuide to Inhaled Treatment Choices
Guide to Inhaled Treatment Choices Note: this is guidance only, it is important to consider which device is best suited to the patient. This may NOT be the first line choice (but should be on the joint
More informationGuide to Inhaled Treatment Choices
Guide to Inhaled Treatment Choices Note: this is guidance only, it is important to consider which device is best suited to the patient. This may NOT be the first line choice (but should be on the joint
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 informationNHS Dumfries & Galloway Triple therapy in COPD patients over 16 years
Title of Project: NHS Dumfries & Galloway Triple therapy in COPD patients over 16 years 1 Reason for the review Respiratory prescribing is long term and can be costly. Appropriate choice and use of inhaled
More informationPocket Guide to Inhaler Technique A Step-By-Step Guide for Healthcare Professionals
Pocket Guide to Inhaler Technique A Step-By-Step Guide for Healthcare Professionals Endorsed by NHSGGC Respiratory Managed Clinical Network; June 2016 Designed by Medical Illustration Services Contents
More informationRespiratory Inhalers. Identification Guide Version 3
Respiratory Inhalers Identification Guide Version 3 This booklet has been prepared by NHSGGC Medicines Information. Endorsed by NHSGGC Respiratory Managed Clinical Network, February 2017. Designed by Medical
More informationCOPD RESOURCE PACK Section 5. Drug Treatment & Inhalers in Stable COPD
COPD RESOURCE PACK Section 5 Drug Treatment & Inhalers in Stable COPD In this section: 1. Links to Fife Formulary 2. Pharmacological Management of Stable COPD 3. How to use a Metered Dose Inhaler 4. How
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 informationCHARM Guidelines for the diagnosis and
\ CHARM Guidelines for the diagnosis and management of COPD City and Hackney CCG Homerton University Hospital NHS Foundation Trust Written by: Miss Hetal Dhruve, Specialist Pharmacist Respiratory Medicine,
More informationGMMMG Asthma Formulary Inhaler Options August 2017
Regular Preventer Beclometasone Beclometasone Beclometasone Brand name Qvar Easi-Breathe Clenil Modulite Easyhaler Device MDI MDI DPI Strengths 50 microgram 100 microgram 200 microgram Adult asthma 2 inhalations
More informationGMMMG COPD Formulary Inhaler Options October 2017
BNF 3.1.1 Adrenocepter agonists (SABA) Salbutamol Salbutamol Terbutaline Brand name Airsalb Ventolin Evohaler Bricanyl Turbohaler Device MDI MDI Dry powder Strengths 100 microgram 100 microgram 500 microgram
More informationCOPD Inhaled Therapy Prescribing Guidance
COPD Inhaled Therapy Prescribing Guidance For Basingstoke, Southampton and Winchester District Prescribing Committee This guidance applies to patients with a COPD DIAGNOSIS CONFIRMED BY POSTBRONCHODILATOR
More informationCOPD Prescribing Guidelines
Cannock Chase Clinical Commissioning Group South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group Stafford and Surrounds Clinical Commissioning Group East Staffordshire Clinical Commissioning
More informationGreater Manchester Asthma Management Plan 2018 Inhaler therapy options for adult patients (18 and over) with asthma
Greater Manchester Asthma Management Plan 2018 Inhaler therapy options for adult patients (18 and over) with asthma Non-pharmacological options for ALL patients, consider at ALL stages Make sure diagnosis
More informationCOPD Inhaled Therapy Prescribing Guidance
COPD Inhaled Therapy Prescribing Guidance For Basingstoke, Southampton and Winchester District Prescribing Committee This guidance applies to patients with a COPD DIAGNOSIS CONFIRMED BY POSTBRONCHODILATOR
More informationASTHMA PRESCRIBING GUIDELINES FOR ADULTS AND CHILDREN OVER 12
North Hampshire CCG Asthma Prescribing Guidelines June 2015 ASTHMA PRESCRIBING GUIDELINES FOR ADULTS AND CHILDREN OVER 12 These guidelines are based on the British Thoracic Society (BTS) and Scottish Intercollegiate
More informationMedicines Management Programme Inhaled Medicines for Chronic Obstructive Pulmonary Disease (COPD)
Medicines Management Programme Inhaled Medicines for Chronic Obstructive Pulmonary Disease (COPD) Approved by Prof. Michael Barry, Clinical Lead, MMP. Date approved Version 1 July 2014 Date updated Version
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 informationInclude patients: with a confirmed diagnosis of asthma who have been free of asthma symptoms for 3 months or more.
Corby Clinical Commissioning Group Kettering General Hospital NHS Trust Nene Clinical Commissioning Group rthampton General Hospital NHS Trust rthamptonshire Healthcare Foundation Trust Stepping down asthma
More informationStepping-down combination ICS/LABA asthma inhaler therapy: Adults 18yrs
Step Down guidance Stepping-down combination ICS/LABA asthma inhaler therapy: Adults 18yrs Important Complete asthma control needs to be achieved for at least 12 weeks before attempting to step patients
More informationChronic Obstructive Pulmonary Disease (COPD) Primary Care Guideline
Chronic Obstructive Pulmonary Disease (COPD) Primary Care Guideline For use across all Norfolk & Waveney CCGs Based on GOLD 2017 1, NICE CG101 COPD 2. Norfolk & Waveney Group In the UK in 2012, 29,776
More informationChronic Obstructive Pulmonary Disease (COPD) Management
DERBYSHIRE JOINT AREA PRESCRIBING COMMITTEE (JAPC) Chronic Obstructive Pulmonary Disease (COPD) Management Diagnosis of COPD should be considered in patients over the age of 35 who have a risk factor (generally
More informationBEDFORDSHIRE AND LUTON JOINT PRESCRIBING COMMITTEE
BEDFORDSHIRE AND LUTON JOINT PRESCRIBING COMMITTEE December 2014 Review Date: December 2017 Bulletin 206 : DuoResp Spiromax 160 / 4.5 and 320 / 9 budesonide & formoterol dry powder inhaler JPC Recommendations
More informationChapter 3: Respiratory System (7 th Edition)
Chapter 3: Respiratory System (7 th Edition) The Sheffield respiratory guidelines (April 2015) have been removed from the intranet. This is because the COPD section has been superseded by the COPD treatment
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 informationAdult Summary flowchart for Asthma Switch and Step Down to ENHCCG preferred inhaler choices
ENHCCG Adult Asthma Switch and Step Down Algorithms - Approved by Hertfordshire Medicines Management Committee June 2016 Page 1 of 6 Adult Summary flowchart for Asthma Switch and Step Down to ENHCCG preferred
More informationAdult Summary flowchart for Asthma Switch and Step Down to preferred inhaler choices
HVCCG Adult Asthma Switch and Step Down Algorithms - Approved by Hertfordshire Medicines Management Committee June 2016 Page 1 of 6 Adult Summary flowchart for Asthma Switch and Step Down to preferred
More informationAsthma Treatment Guideline for Adults (aged 17 and over)
Asthma Treatment Guideline for Adults (aged 17 and over) Sharon Andrew MLCSU January 2019 (Review date 0 January 2022) VERSION CONTROL. Please access via the LMMG website to ensure that the correct version
More information3. Respiratory System
1 3. Respiratory System Also see Appendix 3A Guidance on Management of Also see Appendix 3B Preferred Inhaler Devices for Adults Also see Appendix 3C Preferred Inhaler Devices for Adolescents (12-18 years)
More informationNHS Northern, Eastern and Western Devon Clinical Commissioning Group NHS South Devon and Torbay Clinical Commissioning Group
NHS Northern, Eastern and Western Devon Clinical Commissioning Group NHS South Devon and Torbay Clinical Commissioning Group Inhaler technique and respiratory conditions Guidance Sheet 16 When diagnosed
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 informationTHE COPD PRESCRIBING TOOL
THE COPD PRESCRIBING TOOL Revised edition, 2017 www.bpac.org.nz/copd CLASSIFICATION The COPD prescribing tool This tool provides pharmacological treatment options for patients with COPD based on their
More informationTHEOPHYLLINE WITH INHALED CORTICOSTEROIDS (TWICS) TRIAL SELF MANAGMENT / ACTION PLANS GENUAIR INHALERS: POTENTIAL SAFETY ISSUE
I S S U E 4 M A R C H / A R P I L 2 0 1 6 Endorsed December 2014 I N S I D E T H I S I S S U E : Theophylline with Inhaled Corticosteroids (TWICS) Trial Genuair Inhaler: Potential Safety Issue 1 Self Management
More informationPosition within the Organisation
ASTHMA TREATMENT GUIDELINES Document Description Document Type Service Application Guidelines All healthcare professionals(hcps) caring for patients with asthma Version 4.0 Ratification date September
More informationASTHMA TREATMENT GUIDE (ADULTS)
ASTHMA TREATMENT GUIDE (ADULTS) The BTS/SIGN guideline provides a wide range of information and guidance on the treatment of patients with asthma. https://www.brit-thoracic.org.uk/document-library/clinical-information/asthma/btssign-asthma-guideline-2016/
More informationEvidence Review for Prescribing Clinical Network
Summary page Evidence Review for Prescribing Clinical Network Treatment: LABA/LAMA Combination devices in COPD Anoro Ellipta, Ultibro and Duaklir Genuair Prepared by: Noreen Devanney Topic Submitted by:
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 informationVA/DoD Clinical Practice Guideline Management of COPD Pocket Guide
VA/DoD Clinical Practice Guideline Management of COPD Pocket Guide MODULE A: MAAGEMET OF COPD 1 2 Patient with suspected or confirmed COPD presents to primary care [ A ] See sidebar A Perform brief clinical
More informationMedicines Management of Chronic Obstructive Pulmonary Disorder (COPD)
Medicines Management of Chronic Obstructive Pulmonary Disorder (COPD) Guidelines for Primary Care Guideline Authors: Shaneez Dhanji (NHS Wandsworth) and Reena Rabheru-Dodhy (NHS Sutton & Merton) Date Prepared:
More informationCHRONIC OBSTRUCTIVE PULMONARY DISEASE
CHRONIC OBSTRUCTIVE PULMONARY DISEASE INCIDENCE UP TO 380,000 PEOPLE IN IRELAND HSE FIGURES 110,000 DIAGNOSED AND 200,000 UNDIAGNOSED. AFFECTS MORE MEN THAN WOMEN BUT RATES ARE RISING 1500 DEATHS PER YEAR
More informationCOPD Medications Coverage Summary Non-Insured Health Benefits Coverage SABA Bricanyl turbuhaler Yes Yes
COPD Medications Coverage Summary Drug Non-Insured Health Benefits Coverage SABA Bricanyl turbuhaler Yes Yes Ventolin MDI + generics Yes Yes Ventolin Diskus NO NO Yukon Pharmacare/Chronic Disease Program
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 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 informationDose. Route. Units. Given. Dose. Route. Units. Given
Chapter 4 Respiratory Andrew Stanton SALBUTAMOL (in acute asthma) 5 in acute asthma Nebulised (driven by oxygen not air) 4 6 hourly In acute severe asthma not responding to initial treatment or in life-threatening
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 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. 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 informationSalford COPD Treatment Pathway
Salford COPD Treatment Pathway Development led by Helen Pyne with Salford Asthma and Respiratory Team (SART) Department Respiratory Medicine Salford Royal NHS Foundation Trust Hope Hospital, Stott Lane,
More informationINHALERS for COPD INTRODUCTION. Types of inhalers. Inhaler technique. MDIs for COPD WET AEROSOLS. Dr Christopher Worsnop
INHALERS for COPD Dr Christopher Worsnop Department of Respiratory Medicine Austin Hospital INTRODUCTION Most drugs for COPD are given via inhalers. This reduces the dose that needs to be given and delivers
More informationBEDFORDSHIRE AND LUTON JOINT PRESCRIBING COMMITTEE
BEDFORDSHIRE AND LUTON JOINT PRESCRIBING COMMITTEE Bulletin 218: September 2015 Review Date: September 2018 LAMA / LABA combination inhalers in COPD- Place in therapy review and choice of therapy JPC Recommendations:
More informationProgress, Paediatrics and Protocols. Dr Andy Powell Dr Lesley Ayling West Hampshire CCG
Progress, Paediatrics and Protocols Dr Andy Powell Dr Lesley Ayling West Hampshire CCG Progress Solutions CQUIN discharge bundle (including personal action plan), specialist review, immediate management
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 informationbeclometasone 100 MDI 2 puffs twice a day (recently changed to non CFC (Clenil Modulite))
Case 1 Mr Thomson, a 32 year old asthmatic who is well known to you comes into your pharmacy. He is known to have a best peak flow of 640 L/min. He tells you that over the last few weeks he has been wakening
More informationHow can I benefit most from my COPD medications?
Fact Sheet: COPD Medications and Delivery Devices How can I benefit most from my COPD medications? COPD medications can improve your symptoms. By taking the right medication at the right time, you can
More informationRespiratory Inhaler Check-up Service
Respiratory Inhaler Check-up Service Dr Toby Capstick Lead Respiratory Pharmacist Leeds Teaching Hospitals NHS Trust toby.capstick@nhs.net 8 th May 2018 What is the Challenge? The Burden of Disease in
More informationRESPIRATORY INHALERS
RESPIRATORY INHALERS The correct administration of inhaled therapy is essential for successful, cost-effective and safe therapy. Everyone, including the patient needs to understand the importance of ensuring
More informationCommunity COPD Service Protocol
Community COPD Service Protocol Acknowledgements This protocol is based on the following documents: 1. Chronic obstructive pulmonary disease: Management of chronic obstructive pulmonary disease in adults
More informationChronic Obstructive Pulmonary Disease (COPD)
NHS Eastern Cheshire Clinical Commissioning Group NHS South Cheshire Clinical Commissioning Group NHS Vale Royal Clinical Commissioning Group Mid Cheshire Hospitals NHS Foundation Trust East Cheshire NHS
More informationChronic Obstructive Pulmonary Disease (COPD) Guideline
Chronic Obstructive Pulmonary Disease (COPD) Guideline Unique ID: NHSL Author (s): Professor William MacNee, Dr. Gourab Choudhury. Lothian Respiratory (COPD) MCN Category/Level/Type: Level 2 Guideline
More informationBEDFORDSHIRE AND LUTON JOINT PRESCRIBING COMMITTEE
BEDFORDSHIRE AND LUTON JOINT PRESCRIBING COMMITTEE December 2014 Review date: December 2017 Bulletin 208 : Indacaterol + Glycopyrronium bromide 85/43 micrograms (Ultibro Breezhaler ) for the Treatment
More informationCHARM ASTHMA TREATMENT GUIDELINE
NHS City and Hackney Prescribing Guidelines Adults ( 12 years of age) CHARM ASTHMA TREATMENT GUIDELINE Written by: Hetal Dhruve (Specialist Respiratory Pharmacist, City and Hackney CCG) Checked by: Prof
More informationStepping down asthma treatment guidelines
Stepping down asthma treatment guidelines The potential for inhaled corticosteroids (ICS) to cause dose-related side-effects has led to asthma management guidelines recommending a dose reduction once asthma
More informationAssessing Severity. Management of Stable COPD. General Approach. Short Acting Bronchodilators. Staging System (GOLD)
William P. Saliski Jr. DO Montgomery Pulmonary Consultants Management of Stable COPD Pharmacotherapy Oxygen Smoking Cessation Vaccinations Rehabilitation Surgery Future Discussions Assessing Severity Staging
More informationTest Your Inhaler Knowledge
A Breath of Fresh Air: Updates in COPD Management Jennifer Austin Szwak, PharmD, BCPS, DPLA University of Chicago Medicine The speaker has nothing to disclose Abbreviations COPD: Chronic obstructive pulmonary
More informationBNF CHAPTER 3: RESPIRATORY
3.1 BRONCHODILATORS BNF CHAPTER 3: RESPIRATORY 3.1.1.1 SELECTIVE BETA 2 -AGONISTS Short acting Salbutamol 100 micrograms/actuation aerosol inhaler 100 micrograms/actuation breath-actuated (e.g., Easi-Breathe
More informationWhat is the Challenge?
Respiratory Inhaler Check-up Service What is the Challenge? Dr Toby Capstick Lead Respiratory Pharmacist Leeds Teaching Hospitals NHS Trust toby.capstick@nhs.net 25 th September 2018 The Burden of Disease
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 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 informationSummary of Lothian Joint Formulary Amendments
Summary of Lothian Joint Formulary Amendments The purpose of this summary is to detail the main changes to the LJF sections and provide additional information on the reasons for some of the changes. The
More informationCOPD Update: Focus on Intensifying LABA, LAMA and ICS Therapy
Update: Focus on Intensifying LABA, LAMA and ICS Therapy B.C. Provincial Academic Detailing Service February 2017 Background In Canada, approximately 20 inhaled medications are approved to treat Chronic
More informationA multitude of devices
A multitude of devices Dr Andrew Scroop Respiratory Consultants 15 th September 2018 STEPWISE PHARMACOLOGICAL MANAGEMENT OF STABLE COPD COPD Inhalers MILD FEV 1 60 80% predicted few symptoms breathless
More informationBulletin Independent prescribing information for NHS Wales
Bulletin Independent prescribing information for NHS Wales Respiratory disease September 2014 Respiratory diseases account for one in seven of all deaths in Wales the third largest cause of mortality for
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 informationumeclidinium/vilanterol, 55/22 micrograms, inhalation powder (Anoro ) SMC No. (978/14) GlaxoSmithKline
umeclidinium/vilanterol, 55/22 micrograms, inhalation powder (Anoro ) SMC No. (978/14) GlaxoSmithKline 04 July 2014 The Scottish Medicines Consortium (SMC) has completed its assessment of the above product
More informationMetered Dose Inhaler (MDI)
Metered Dose Inhaler (MDI) If the inhaler has not been used before, a test dose should be fired into the air to prime the system. 1. Remove cap. 2. Shake well. 3. Breathe out fully. 4. Holding inhaler
More informationRespiratory Health. Asthma and COPD
Respiratory Health Asthma and COPD Definition of asthma Working definition by AAH 2014: Chronic lung disease Can be controlled not cured Large variation in lung function Large variation in respiratory
More information500 micrograms/dose Turbohaler dry powder device 500 micrograms/ml injection. 12 micrograms/dose Turbohaler dry powder device
3.1 BRONCHODILATORS 3.1.1.1 SELECTIVE BETA 2 -AGONISTS Short acting Salbutamol Terbutaline 100 micrograms/actuation aerosol inhaler 100 micrograms/actuation breath-actuated e.g. Easi-Breathe 200 micrograms/dose
More informationNational COPD Audit Programme
National COPD Audit Programme Planning for every breath National Chronic Obstructive Pulmonary Disease (COPD) Audit Programme: Primary care audit () 2015 17 Data analysis and methodology Section 4: Providing
More informationCOPD Patient Care Pathway
COPD Patient Care Pathway Northumberland Clinical Commissioning Group North Tyneside Clinical Commissioning Group Contents The Pathway 1. Identification and Diagnosis.......................P3 2. Annual
More informationBEDFORDSHIRE AND LUTON JOINT PRESCRIBING COMMITTEE
BEDFORDSHIRE AND LUTON JOINT PRESCRIBING COMMITTEE September 2015 Review Date: September 2018 Bulletin 219: Choice of Long Acting Muscarinic Agent (LAMA) inhaler for COPD JPC Recommendation: The availability
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 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 informationOutline. EPIC Project. February EPIC Project. Diagnosis: Spirometry. Differentiation between COPD & Asthma
EPIC Project Enabling Patient health Improvements though COPD medicines optimisation Dr Toby Capstick Toby.capstick@nhs.net Outline Background on COPD COPD Assessment Cost Effective Treatment Medication
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 informationClinical Policy: Roflumilast (Daliresp) Reference Number: CP.PMN.46 Effective Date: Last Review Date: 08.18
Clinical Policy: (Daliresp) Reference Number: CP.PMN.46 Effective Date: 11.01.11 Last Review Date: 08.18 Line of Business: Medicaid Revision Log See Important Reminder at the end of this policy for important
More informationMedicines Management of Asthma
Wandsworth Borough Team Medicines Management of Guidelines for Primary Care September 2011 Version 1 Guideline Authors: Shaneez Dhanji (Wandsworth borough) Reena Rabheru-Dodhy (Sutton & Merton borough)
More informationMedical Directive. Activation Date: April 24, 2013 Review due by: December 1, Medical Director: Date: December 1, 2017
Medical Directive Pre and Post Bronchodilator Spirometry Testing and Treatment Initiation Assigned Number: Activation Date: April 24, 2013 Review due by: December 1, 2019 23 Approval Signature & Date Medical
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 informationCDEC FINAL RECOMMENDATION
CDEC FINAL RECOMMENDATION (FLUTICASONE FUROATE/VILANTEROL) (Breo Ellipta GlaxoSmithKline) Indication: Chronic Obstructive Pulmonary Disease Recommendation: The Canadian Drug Expert Committee (CDEC) recommends
More information