What is New in COPD: Times Are Changing! Meredith Chiasson, MD, FRCPC April 6, 2018
|
|
- Kristian Mills
- 5 years ago
- Views:
Transcription
1 What is New in COPD: Times Are Changing! Meredith Chiasson, MD, FRCPC April 6, 2018
2 No disclosures Disclosures
3 objectives How to diagnose & Assess severity Treatment: Pharmacologic Non-Pharmacologic Maintenance Spirometry Inhalers Smoking Cessation Vaccines Rehabilitation Oxygen Treatment of Exacerbation Palliative Care INSPIRED
4 What is COPD??? Respiratory disorder largely caused by smoking, and is characterized by progressive, partially reversible airway obstruction and lung hyperinflation, systemic manifestations and increasing frequency and severity of exacerbations COPD is not asthma and should be managed differently. Can Respir J, 2008; 15(Suppl A): 1A-8A.
5 Diagnosis Clinical Suspicion Cough Shortness of Breath Sputum.. Screen all smokers?
6 Diagnosis POST bronchodilator spirometry NOT CXR Emphysema can be seen on CT Barriers??
7 Why is Diagnosis important?
8 How to assess severity? Spirometry Clinical degree of symptoms
9
10 MRC Class
11 COPD in Canada: Epidemiology and Costs
12 Percent Change in Age-Adjusted Death Rates, U.S., (Proportion of 1965 Rate)
13 How to Decrease Mortality? Short Term: Non-invasive ventilation Long Term: 1. Smoking cessation 2. Home oxygen (?? Still the case) 3. Lung volume reduction surgery Can Respir J, 2008; 15(Suppl A): 1A-8A.
14 Basic framework Confirm the diagnosis spirometry Treatment Pharmacologic Non-Pharmacologic Maintenance Spirometry Inhalers Smoking Cessation Vaccines Rehabilitation Oxygen Treatment of Exacerbation Palliative Care INSPIRED
15 <30% >80%
16
17
18 Short Acting
19
20 Seebri 50mcg, 1 capsule 2 puffs daily Turdoza 400mcg1 puff B.I.D. LAMA (AKA LAAC) Spiriva Handihaler 18mcg, 1 capsule 2 puffs daily Spiriva Respimat 2.5mcg 2 puffs daily Incruse 62.5mcg, 1 puff daily
21 LAMA (AKA LAAC) LAMA vs placebo: Less dyspnea, exacerbations and fewer hospitalizations Better lung function, QoL LAMA vs SABA: Improved lung function Less frequent exacerbation and hospitalizations Fewer withdrawals from clinical trials. LAMA vs LABA Fewer exacerbations and hospitalizations Equal improvement in lung function, QoL Similar withdrawal from studies
22 LAMA (AKA LAAC) - MSI Moderate - severe COPD (ratio <70%, FEV1<60%) OR Inadequate response to short acting bronchodilators MRC Grade 3 after 2 months of: 8 puffs/day of short acting beta-2 agonist or 12 puffs/day of ipratropium or 6 puffs/day of ipratropium/salbutamol combo inhaler
23
24 LABA Equal class effects (as with LAMA) Foradil 12mcg 1 puff B.I.D. Oxese 6 or 12mcg 1 puff B.I.D. Onbrez 75mcg 1 puff daily Serevent 50mcg 1 puff B.I.D.
25 LABA - MSI Moderate - severe COPD (ratio <70%, FEV1<60%) OR Inadequate response to short acting bronchodilators MRC Grade 3 after 2 months of: 8 puffs/day of short acting beta-2 agonist or 12 puffs/day of ipratropium or 6 puffs/day of ipratropium/salbutamol combo inhaler
26 FLAME FLAME
27 LAMA/LABA Anoro 62.5mcg 1 puff daily Ultibro 50mcg (1 capsule) 2 puffs daily Inspiolto 2.5mcg 2 puffs daily Duaklir 400mcg 1 puff B.I.D.
28 LAMA/LABA - MSI Moderate - severe COPD (ratio <70%, FEV1<60%) Inadequate response to 2 months of LAMA or LABA
29 TORCH TORCH
30 ICS/LABA Advair Diskus (250mcg or 500mcg) 1 puff B.I.D. MDI (125mcg or 250mcg) 1 or 2 puffs B.I.D. Breo 100mcg (200mcg for asthma) 1 puff daily Symbicort 100mcg or 200mcg 1 or 2 puffs B.I.D. Zenhale is not approved for COPD in Canada
31 ICS/LABA TORCH trial rigorous study Decreased exacerbations by 25% Just missed mortality benefit (p=0.52) if had run longer most feel would have hit significance for mortality. Increased risk of pneumonia (NNH = 17)
32 LABA/ICS - MSI Frequent exacerbators
33
34 LABA/ICS + LAMA Moderate - severe COPD (ratio <70%, FEV1<60%) COPD exacerbation(s) ( in symptoms needing antibiotics &/or oral or IV steroids). Inadequate response to LABA/ICS or LAMA after 2 months.
35 Inhaled Corticosteroids (ICS)
36 objectives How to diagnose & Assess severity Treatment: Pharmacologic Non-Pharmacologic Maintenance Spirometry Inhalers Smoking Cessation Vaccines Rehabilitation Oxygen Treatment of Exacerbation Palliative Care INSPIRED
37 Vaccinations Annual influenza vaccines Reduces hospitalization Reduces the number of COPD exacerbations (Cochrane 2010) Pneumococcal vaccination Pneumovax (polysaccharide) with a boost 5-10 years later in high risk COPD patients (Conj vaccine if immunosuppressed)
38 objectives How to diagnose & Assess severity Treatment: Pharmacologic Non-Pharmacologic Maintenance Spirometry Inhalers Smoking Cessation Vaccines Rehabilitation Oxygen Treatment of Exacerbation Palliative Care INSPIRED
39 Oxygen MRC & NOTT trials Only therapy with mortality benefit Coverage: government & private Criteria: Non-smoker, at stable baseline On maximal medical therapy po2<55mmhg (<60 if right heart failure) Desaturation <80% with ambulation Overnight
40 NOTT AIM MRC Lancet 1981 Home Oxygen
41 Do you always want to prescribe? Compressor, 120 feet tubing 10 oxygen tanks Fall hazard Social stigma Discomfort ears and nose
42 objectives How to diagnose & Assess severity Treatment: Pharmacologic Non-Pharmacologic Maintenance Spirometry Inhalers Smoking Cessation Vaccines Rehabilitation Oxygen Treatment of Exacerbation Palliative Care INSPIRED
43 COPD Exacerbation Acute increase in sx s beyond normal day-to-day variation: More severe and frequent cough More sputum, or change in character More SOB Exacerbations cause morbidity & mortality CXR usually unchanged, may have pneumonia Spirometry usually worsens
44 Acute Event Mortality AECOPD 22-43% of patients hospitalized with a AECOPD die within 1 year (1,2,3,4) In-hospital mortality rate for AECOPD is 8-11% (1,2) Acute MI 25% of men & 38% of women die within 1 year of 1 st recognized MI (5,6) In-hospital acute MI mortality rate is 8-9.4% (5,6) 1. Eriksen N. Ugeskr Laeger 2003;165: Connors AF. Am J Respir Crit Care Med 1996;154: Groenewegen KH. Chest 2003;124: Thom T et al. Circulation Almagro P. Chest 2002;121: Heart and Stroke Foundation of Canada
45 # of Patients AECOPD - #1 Cause for Hospital Admissions Among Chronic Illness in Canada 18,000 16,000 14,000 COPD Angina Asthma 12,000 10,000 8,000 6,000 Heart Failure Diabetes 2 or more repeat hospitalizations 1 repeat hospitalization Single hospitalization 4,000 2,000 0 Health Indicators Canadian Institute of Health Information. Page 21.
46 Corticosteroids in COPD Aaron, SD. NEJM, 2003; 348:
47 Exacerbation - Antibiotics When (Anthonisen criteria) beneficial to treat more severe purulent AECOPD What Increased SOB Increased sputum volume Increased purulence Simple vs complex exacerbation Have they had antibiotics in the last 3 months
48 Recommendations for ABX - What Simple Exacerbation Amoxicillin Cefuroxime Doxycycline TMP/SMX Azithromycin Complicated Exacerbation* Resp. fluoroquinolone Amox/Clav * FEV1 <50% or IHD >4 AECOPD per yr home O 2 chronic oral steroids
49 COPD Action Plan
50 Basic framework Confirm the diagnosis spirometry Treatment Pharmacologic Non-Pharmacologic Maintenance Spirometry Inhalers Smoking Cessation Vaccines Rehabilitation Oxygen Treatment of Exacerbation Palliative Care INSPIRED
51 Smoking Cessation
52 Smoking Cessation Cold turkey is best Cutting Smoking down to Cessation quit does Counselling not work Switching to e-cigarettes to quit does Refer to Tracey Cushing (R.T.) not work (jury is still out as to whether or not e-cigarettes Cobequid are safer) Counselling with pharmacologic therapy has best evidence.
53 objectives How to diagnose & Assess severity Treatment: Pharmacologic Non-Pharmacologic Maintenance Spirometry Inhalers Smoking Cessation Vaccines Rehabilitation Oxygen Treatment of Exacerbation Palliative Care INSPIRED
54 Rehabilitation Cobequid and Mumford road Two days per week for three months 1 st hour is weight lifting and aerobic exercise (treadmill, bike, arm bike) 2 nd hour is counselling (smoking cessation, how to eat, how to breath etc)
55 Benefits of Pulmonary Rehabilitation
56 Key Message
57 objectives How to diagnose & Assess severity Treatment: Pharmacologic Non-Pharmacologic Maintenance Spirometry Inhalers Smoking Cessation Vaccines Rehabilitation Oxygen Treatment of Exacerbation Palliative Care INSPIRED
58 Palliative Care Referral is challenging in Halifax (imminent death) Best to refer early and have at least one session in regards to advanced care planning/advanced directives, where they would like to die etc.
59 End of Life Care Who is at increased risk of death: Very severe airflow obstruction (FEV1 <30%), with hyperinflation ( TLC & FRC) MRC 4-5 BMI < 19 Older age Recurrent exacerbations (hospitalization and intubation) Pulmonary hypertension Can Respir J, 2008; 15(Suppl A): 1A-8A.
60 Case
61 Case - Presentation 65yo man in your office Current smoker 30 pack years SOB walks slower than most people own age (MRC 3). Daily smoker s cough productive of yellow sputum. No hemoptysis., Ventolin & Atrovent x 5 years. Unwell 2-3x/year for which you treat him with an antibiotic.
62 Case - Presentation PMHx: hypercholesterolemia, HTN,? TIA, stable angina MEDS: rosuvastatin, HCTZ, ASA, Ventolin, atrovent Vaccines: none recently ALLERGIES: None P/E: HR 110, RR 24, Spo2 87% on R/A, BP 162/98, afebrile Decreased breath sounds throughout, scattered wheezes, 1+ peripheral edema.
63 Case - Investigations Post bronchodilator PFTs, baseline FVC 2.94 (61%) FEV (16%) Ratio 21% Reduced Obstruction
64 Basic framework Pharmacologic Non-Pharmacologic Maintenance Inhalers Vaccines Oxygen Treatment of Exacerbation Spirometry Smoking Cessation Rehabilitation Palliative Care INSPIRED
65 Inhalers With his lung function and exacerbation history you can put him on triple therapy but not dual. Can start with LAMA, or tripple If you choose LAMA, then you can upgrade to LAMA/LABA (dual) in two months.
66 Seebri 50mcg, 1 capsule 2 puffs daily Turdoza 400mcg1 puff B.I.D. LAMA Spiriva Handihaler 18mcg, 1 capsule 2 puffs daily Spiriva Respimat 2.5mcg 2 puffs daily Incruse 62.5mcg, 1 puff daily
67 ICS/LABA Advair Diskus (250mcg or 500mcg) 1 puff B.I.D. MDI (125mcg or 250mcg) 1 or 2 puffs B.I.D. Breo 100mcg (200mcg for asthma) 1 puff daily Symbicort 100mcg or 200mcg 1 or 2 puffs B.I.D.
68 0.61 (16%) 21%
69 6 Amox/Clav 875mg BID X 3repeats Doxycyclin 100mg 4 Ventolin BID X 3repeats 50mg 5 OD 5 X 6repeats COPD Action Plan
70 Vaccination Yearly influenza vaccine Pneumovax every ten years (regardless of age!)
71 Oxygen Does not qualify as continues to smoke! If he quits need to refer to a specialist with oxygen prescribing capabilities PaO2<55mmHg or <60mmHg if right heart failure <80% on 6 minute walk test.
72 Non-Pharmacologic Smoking cessation even brief intervention can be worthwhile Rehabilitation Great idea! INSPIRED even continues to exacerbate Palliative care too early
73 Basic framework Pharmacologic Non-Pharmacologic Maintenance Inhalers Vaccines Oxygen Treatment of Exacerbation Spirometry Smoking Cessation Rehabilitation Palliative Care INSPIRED
74 Basic framework Pharmacologic Non-Pharmacologic Inhalers Spirometry Action Plan Smoking Cessation Vaccines Rehabilitation Oxygen Palliative Care
75 Livingwellwithcopd.com
76 Fee Code - COPD DoctorsNS/ContinuingCareFees.pdf
77
78 References Gold 2017 and 2011
79 INSPIRED Program Outreach program Working with patients in the HRM who have advanced COPD Those who require frequent visits to health care facilities, or who cannot make it to outpatient respirology clinic Team is composed of a physician, respiratory therapist and spiritual care
SABA: 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 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 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: 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 informationPrescribing guidelines: Management of COPD in Primary Care
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
More informationCOPD Treatable. Preventable.
My COPD Action Plan Patient s Copy (Patient s Name) Date Canadian Respiratory COPD Treatable. Preventable. This is to tell me how I will take care of myself when I have a COPD flare-up. My goals are My
More informationThree better than 1 or 2?
Three better than 1 or 2? DISCLOSURE Pam McLean-Veysey, Team Leader Drug Evaluation Unit DEU funded by the Drug Evaluation Alliance of NS. (DEANS). DEU prepares Drug Evaluation Reports for the Atlantic
More informationUpdate on Pulmonary Diseases. Jeffrey Lessar, MD
Update on Pulmonary Diseases Jeffrey Lessar, MD 1 No disclosures to make No conflicts 2 Goals Update on key changes in Pulmonary Therapy 3 Spirometry Spirometry FEV1- forced expiratory Volume in 1 Sec
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 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 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 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 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 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 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 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 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 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 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 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 informationCOPD 2016 What to do with all these New Inhalers?
COPD 2016 What to do with all these New Inhalers? Planning committee Content Experts Clinical reviewers Paul Hernandez MDCM FRCPC, Department of Respirology, QEII Health Sciences Centre, Associate Professor,
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 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 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 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 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 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 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 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 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 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 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 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 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 informationPulmonary Year in Review
Pulmonary Year in Review Rachel Givelber, MD University of Pittsburgh SOM Pulmonary, Allergy, Critical Care and Sleep Medicine Rachel Givelber, MD Assistant Professor of Medicine PACCM, UPSOM Disclosures
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 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 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 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 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 informationShared System of Care COPD/Heart Failure
Shared System of Care COPD/Heart Failure Learning Session 2 www.pspbc.ca Agenda Introduction (35) Sharing Experiences(10) Medication (60, 40 didactic and 20 discussion) MOA Breakout Break (15) PSM Support
More information62 year old man with a cough! Dr. Aflah Sadikeen Consultant Respiratory Physician Colombo
62 year old man with a cough! Dr. Aflah Sadikeen Consultant Respiratory Physician Colombo History Mr.KS, a 62 year-old, has been feeling unwell - Worsening cough for the last 5 days - Feels out of breath
More informationPulmonary and Critical Care Year in Review
Pulmonary and Critical Care Year in Review Heath E Latham, MD Assistant Professor University of Kansas Dept of Internal Medicine Division of Pulmonary and Critical Care None Disclosure Lung Cancer Screening
More informationKnown Allergies: Shellfish. Symptoms: abdominal pain, nausea, diarrhea, or vomiting. congestion, trouble breathing, or wheezing.
CSTAR CASE STUDIES: BLOCK B Asthma or COPD? Setting: Walk in clinic. Dan: I havi g that cough thi g agai HPI: Dan is a 49-year-old male teacher who reports having had episodes of cough with mucus production
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 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 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 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 informationCOPD The New Epidemic. Peter Lin MD CCFP Director Primary Care Initiatives Canadian Heart Research Centre
COPD The New Epidemic Peter Lin MD CCFP Director Primary Care Initiatives Canadian Heart Research Centre Conflict Disclosure Information Speaker: Dr. Peter Lin Title of Talk: COPD The New Epidemic Financial
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 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 informationChronic Obstructive Pulmonary Disease
Chronic Obstructive Pulmonary Disease 07 Contributor Dr David Tan Hsien Yung Definition, Diagnosis and Risk Factors for (COPD) Differential Diagnoses Goals of Management Management of COPD THERAPY AT EACH
More informationImproving Outcomes in COPD
Neil MacIntyre MD Duke University Durham NC Current treatment guidelines f COPD focus Barriers to providing optimal treatment Diagnosis of COPD EXPOSURE TO RISK FACTORS AND/ OR SYMPTOMS sputum cough dyspnea
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 informationDebating the use of inhaled corticosteroids in the treatment of COPD. COPD Epidemiology. A quick patient case. Risk Factors for COPD 1,2
Debating the use of inhaled corticosteroids in the treatment of COPD Suzanne G. Bollmeier Pharm.D., BCPS, AE-C Associate Professor, St. Louis College of Pharmacy ACPE Guidelines on Non- Commercialism o
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 informationDr Stephen Child. General Physician Auckland. 14:20-14:40 Secondary Care Perspective
Dr Stephen Child General Physician Auckland 14:20-14:40 Secondary Care Perspective Wheeze Witchery Stephen Child MD, FRACP, FRCPC General Physician Respiratory Interest Director of Clinical Training Auckland
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 informationMichelle Zeidler, MD, MS
7/1/18 Chronic Obstructive Pulmonary Disease: Optimizing Outpatient Care & Reducing Exacerbations Michelle Zeidler, MD, MS Professor of Medicine, Pulmonary, Critical Care Medicine & Sleep Medicine, VA
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 informationChronic Obstructive Pulmonary Disease (COPD)
Chronic Obstructive Pulmonary Disease (COPD) Scope: The guideline provides strategies for the improved diagnosis and management of adults with chronic bronchitis and emphysema (chronic obstructive pulmonary
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 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 informationCOPD. Stan Kellar, MD. Physiology 11/4/2014. Chief of Clinical Affairs, BH NLR Pulmonary Medicine Sleep Medicine
Stan Kellar, MD Chief of Clinical Affairs, BH NLR Pulmonary Medicine Sleep Medicine COPD Physiology The lungs are filters Filter in oxygen Filter out carbon dioxide (Vascular filter, not part of this discussion)
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 informationHQO s Episode of Care for Chronic Obstructive Pulmonary Disease
HQO s Episode of Care for Chronic Obstructive Pulmonary Disease Dr. Chaim Bell, MD PhD FRCPC Ontario Hospital Association Webcast October 23, 2013 Objectives 1. Describe the rationale and methodology for
More informationCOPD Diagnosis, Management and Program
COPD Diagnosis, Management and Program RYAN MARTIN, MD NEBRASKA PULMONARY SPECIALTIES Initial diagnosis Setting matters: Inpatient. Usually sicker, oftentimes avoiding healthcare. Outpatient. Often seeking
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 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 informationBreaking Down Barriers to Pulmonary Therapies: Patient Education, Teach Back, and More
Breaking Down Barriers to Pulmonary Therapies: Patient Education, Teach Back, and More Char Raley, RRT Brandon Johnson, PharmD, BCPS Pulmonary and Critical Care Symposium June 12 th, 2015 We have had no
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 informationPharmacological Management of Obstructive Airways in Humans. Introduction to Scientific Research. Submitted: 12/4/08
Pharmacological Management of Obstructive Airways in Humans Introduction to Scientific Research Submitted: 12/4/08 Introduction: Obstructive airways can be characterized as inflammation or structural changes
More informationSTRIVERDI RESPIMAT (olodaterol hcl) aerosol
STRIVERDI RESPIMAT (olodaterol hcl) aerosol Coverage for services, procedures, medical devices and drugs are dependent upon benefit eligibility as outlined in the member's specific benefit plan. This Pharmacy
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 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 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 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 informationCommon Drug Review Pharmacoeconomic Review Report
Common Drug Review Pharmacoeconomic Review Report January 2018 Drug umeclidinium bromide (Incruse Ellipta) Indication Listing request Dosage form(s) Manufacturer Indicated for long-term, once daily maintenance
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, 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 information