9/14/12. Nicole Paterson, PharmD BCPS Medication Therapy Management Provider Fairview Pharmacy Services, LLC

Size: px
Start display at page:

Download "9/14/12. Nicole Paterson, PharmD BCPS Medication Therapy Management Provider Fairview Pharmacy Services, LLC"

Transcription

1 Nicole Paterson, PharmD BCPS Medication Therapy Management Provider Fairview Pharmacy Services, LLC } Describe the pathophysiology of asthma and Chronic Obstructive Pulmonary Disease (COPD). } Review the asthma and COPD guidelines and available treatment options. } Discuss how pharmacist can play a key role in asthma and COPD patient education. } A common chronic disorder of the airways that involves airflow obstruction, bronchial hyperresponsiveness and an underlying inflammation } Recurrent episodes of wheezing, chest tightness, shortness of breath, and cough } Widespread, variable, and reversible (not always completely) airflow obstruction 1

2 } Control chronic and nighttime symptoms Rules of two : Do you use a quick relief inhaler more than 2 times per week? Do you awaken at night due to asthma more than 2 times per month? Do you refill your quick relief inhaler prescription more than 2 times per year? } Maintain normal activity levels, including exercise } Maintain near-normal pulmonary function } Prevent acute episodes of asthma } Minimize emergency department visits and hospitalizations } Avoid adverse effects of asthma medications Baylor Healthcare System } Social history: Works as football coach, married } Current complaint: Feels asthma may contribute to difficulty going back to sleep after getting up to go to the bathroom. } Asthma: Uses albuterol nebulizer in the AM and at bedtime, he feels relaxation for about 4 hours and then his breathing becomes less comfortable. Notices symptoms after heavy lifting, such as snow shoveling. He has run out of his rescue inhaler. } Former smoker of cigars, rare alcohol use } Vaccinations: influenza vaccine this year, Tdap 2009 } Medications for Asthma & Allergies: albuterol 0.83% nebs 3ml every 4 hours prn, cetirizine 10mg QD (reports allergies are good) } On theophylline 200mg SR twice daily for post infarct adenosine release and bradyarrthymias. Hospital note from cardiology in 2010 plan was to stop this. } Comorbid conditions: hypertension, hyperlipidemia, arteriosclerotic cardiovascular disease (MI, angioplasty & stent 2010), rosacea, squamous cell carcinoma of skin } Weight: 266 lbs, BP 135/73 P 90 } Asthma Control Test=15, theophylline level 2.6 2

3 Asthma Mechanism } Controller Medications Daily Long-term control Anti-inflammatory } Reliever (rescue) Medications As needed Quick relief Bronchodilators 3

4 Controller Medications - Daily Corticosteroids (inhaled and systemic) (ICS) Long-acting beta 2 -agonists (LABA) Combination therapy Leukotriene modifiers (LTRA) Cromolyn sodium - Nedocromil sodium Sustained-release theophylline Allergy Immunotherapy - Omalizumab Reliever (or Rescue) Medications Short acting beta 2 -agonists (SABA) Systemic corticosteroids: Burst Therapy Anticholinergics Inhaled Beclomethasone (QVAR ) Budesonide (Pulmicort ) Fluticasone (Flovent ) Mometasone (Asmanex ) Ciclesonide (Alvesco ) Triamcinolone (Azmacort ) (n/a 2010) Flunisolide (AeroBid ) (n/a 2011) Systemic (Oral/IV) Prednisone (generic) Methylprednisolone (Medrol, Solu-medrol ) Prednisolone (Prelone ) } Most effective long-term control therapy for persistent asthma } Reduced airway inflammation Decreases airway hyperresponsiveness Stabilize the lung tissue } Maximum Effects: Inhaled: Days to Weeks (maybe months) Versus Oral prednisone: 6 to 24 hours **NEVER FOR RESCUE PURPOSES** 4

5 Inhaled Local } Dysphonia } Thrush } Cough/throat irritation } Impaired growth rate (high dose??) Systemic (oral, IV) } Fluid retention } Muscle weakness } Ulcers } Malaise } Impaired wound healing } Mood alteration } Weight gain } Impaired glucose } Hypertension } N/V, HA } Osteoporosis (adults) } Cataracts (adults) } Glaucoma (adults) } Salmeterol (Serevent ), Formoterol (Foradil ) Indication: Daily long-term control bronchodilator } Mechanism Long term stimulation of beta 2 receptors } Advantages Blunt exercise induced symptoms for longer time Decrease nocturnal symptoms Improve quality of life } Side effects Tachycardia, skeletal muscle tremor, hypokalemia, prolongation of QTc interval in overdose } NOT for acute symptoms or exacerbations Onset of effect: 3 minutes (formoterol), 30 minutes (salmeterol) Duration of effect: up to 12 hours } NOT a substitute for anti-inflammatory therapy } NOT FOR MONOTHERAPY IN ASTHMA Found an increased risk of severe asthma exacerbation leading to hospitalization and even death when using LABA for asthma prevention 5

6 } Fluticasone/Salmeterol (Advair Diskus and HFA) Disk: 1 inhalation twice daily Low 100/50, Medium 250/50, High 500/50 HFA: 2 puffs twice daily Low 45/21, Medium 115/21, High 230/21 } Budesonide/Formoterol (Symbicort HFA) 2 puffs twice daily Low: 80/4.5, Medium: 160/4.5 } Mometasone/Formoterol (Dulera HFA ) 2 puffs twice daily Medium: 100/5, High: 200/5 } Prevent inflammation Montelukast (Singulair ) Once a day in PM 4 mg granules (in C.A.I.R), 4 mg, 5 mg chewable, 10 mg tablet Pediatric indication > 1 year No food restrictions Zafirlukast (Accolate ) Twice daily empty stomach Indicated > 5 yo Many drug interactions; monitor liver enzymes Zileuton (Zyflo CR ) 600mg IR QID, 1200mg ER BID Indicated > 12 yo Many drug interactions; monitor liver enzymes Short acting beta 2 -agonists } Albuterol (ProAir, Proventil, Ventolin ) } Levalbuterol (Xopenex ) } Pirbuterol (Maxair ) (n/a after 2013) Anticholinergics } Ipratropium (Atrovent ) Systemic corticosteroids Burst Therapy } Prednisone } Prednisolone (Prelone ) } Methylprednisolone (Medrol ) 6

7 Beta 2 -Agonist Increased heart rate Palpitations Nervousness Sleeplessness Headache Tremor Anticholingeric Drying of mouth and secretions Constipation Blurred vision if sprayed in eyes Produces less cardiac stimulation than SABAs Regularly scheduled use not generally recommended use as needed May lower effectiveness May increase airway hyperresponsiveness (Accessed 8/13/2012). (Accessed 8/13/2012). 7

8 } Actions: November mometasone inhaler started, refilled albuterol inhaler, theophylline discontinued, asthma education, referral in for sleep clinic } Follow-up: January he has cold exacerbation and urgent care visit added montelukast 10mg daily + prednisone taper } Feburary he had a asthma flare and he had stopped mometasone inhaler prior to this. Montelukast continued, fluticasone/salmeterol 250/50 disc 1 inh twice daily started + prednisone taper. Sleep apnea diagnosis. } May MTM follow-up ACT=23, missing montelukast at times, pneumoccocal vaccine given, Asthma Action Plan reviewed, continues to work on getting CPAP started. } Seasonal Influenza Yearly immunization-trivalent influenza vaccine (TIV) or high dose if >65 years old Not recommended: intanasal influenza vaccine (Flumist) } Pneumococcal Age >2 years: 23-valent polysaccharide vaccine (PPSV) if received high dose steroids in asthma Age >19 years old: PPSV if have asthma, COPD, or smoker Persons who received PPSV before age 65 years for any indication should receive another dose of the vaccine at age 65 years or later if at least 5 years have passed since their previous dose Recommended Adult Immunization Schedule United States From Advisory Committee on Immunization Practices (ACIP). MMWR 2012;61(No. 4). Accessed at vaccines/schedules/hcp/adult.html. Control Medication: Fluticasone/salmeterol disc 250/50 1 puff twice daily + montelukast 10mg daily Rescue Medication: Albuterol inh 2 puffs every 4 hours Allergies Triggers: Seasonal allergies, upper respiratory tract infections, smoke 8

9 } Infections Common Cold #1 Trigger } Allergens Animal dander Cockroaches Dust mites Mold Pollen Foods/additives } Irritants Smoke, dust, strong odors, cold/humid air } Behaviors Emotions, exercise, smoking } Social history: attends grade school } Current complaint: Mom reports she is hesitant to give her son medications due to side effects, he was doing better but getting some coughing recently. It was hard to tell when Matt was declining in symptoms, suddenly it was so severe. } PMH: Asthma diagnosed age 18 months, recent ER visit for asthma 1 month ago, last ER visit was 2 years prior } Medications for asthma that Mom brings in: Fluticasone inhaler 110mcg, Budesonide nebs, levalbuterol 0.63mg/3ml nebs, ipatropium nebs, montelukast 5mg chewable tab daily, prednisone 25mg twice daily for flares, has Optichamber spacer } Comorbid conditions: none } Asthma Triggers: Upper respiratory track infections } Asthma Control Test= 14 } Assessment: Inhaler technique poor 9

10 Optimal Technique: Shake inhaler for 10 seconds Actuation during a slow (30 l/m or 3-5 seconds) deep inhalation, followed by a 10 second breathhold. Under laboratory conditions, open-mouth technique (holding MDI 2 inches away from open mouth) enhances delivery to the lung. However, it has not consistently been shown to enhance clinical benefit compared to closed-mouth technique (closing mouth around MDI mouthpiece) The successful use of Metered Dose Inhalers requires that patients: } Shake inhaler } Inspire at actuation } Inhale slowly } Hold their breath } Exhale slowly } Easier to use, and more effective, than MDI alone } Spacers/holding chambers decrease oropharyngeal deposition and will reduce potential system absorption of inhaled corticosteriod preparations } A spacer device with a one-way valve, i.e., holding chamber, eliminates the need for the patient to coordinate actuation with inhalation and optimizes drug delivery. 10

11 (Accessed 8/13/2012). } Actions: Asthma education Educated on proper inhaler technique Consistently stay on fluticasone inhaler 110mg twice a day with spacer Do Peak Flow Meter Asthma Action Plan reviewed } Follow-up 1 month later: ACT=26, best peak flow was 220, AAP made with peak flow readings. If stable for next 3 months, consider step down to fluticasone 44mcg inhaler 1 puff twice a day. } Asthmatic vs. normal airways } What happens in an asthma attack } Control vs. Quick relief medications } Using controller medications regularly } How medications work (review inhaler technique) } Side effects of medications } Environmental control measures } Responding to changes in control } Following the Asthma Action Plan 11

12 } Preventable and treatable disease with some significant extrapulmonary effects that may contribute to the severity in individual patients } Airflow limitation that is not fully reversible } Usually progressive and associated with an abnormal inflammatory response of the lung to noxious particles or gases } Cough } Sputum production } Dyspnea on exertion } Episodes of acute worsening of these symptoms often occur 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 Adapted from Global Strategy for Diagnosis, Management and Prevention of COPD, (assessed 8/18/12) 12

13 } Relieve symptoms } Improve exercise tolerance } Improve health status Reduce Symptoms } Prevent disease progression Reduce } Prevent and treat exacerbations Risk } Reduce mortality } Prevent or minimize side effects from treatment Adapted from Global Strategy for Diagnosis, Management and Prevention of COPD, (assessed 8/18/12) } Social history: Was working as caretaker cleaning (exposed to chemical cleaning agents), disabled 6 months ago } Current complaint: Can not afford copays, primary doctor encouraged this visit with MTM today } COPD meds: Tiotropium inh 18mcg daily, fluticasone/salmeterol mcg disc 1 puff twice daily, albuterol inh 2 puffs q4 PRN, oxygen continuous at 3 liters } Spirometry: FEV 1 42% predicted, FEV1/FVC<0.60 } Comorbid conditions: pulmonary hypertension, obstructive sleep apnea, heart failure, hypertension, hyperlipidemia, depression, GERD, allergies, diabetes, fibromyalgia, obesity } Smoking: 0.5 packs/day for 20 years, currently smoking 10 cigarettes per day, currently in stressful situation with needing to move to a different apartment } Vaccinations: not received influenza vaccine this year, received pneumoccal vaccine 13

14 } Avoid risk factors: Tobacco Cessation Avoid air pollution Reduce occupational exposure } Immunizations } Pulmonary Rehabilitation } Physical Activity } Pharmacotherapy } Supplemental Oxygen Therapy } Surgical treatments Lung transplantation, lung volume reduction surgery Forced Expiratory Volume in 1 Second (FEV 1 ) [% of Value at Age 25] Smoke regularly and susceptible to 50 its effects Disability 25 Death * * Age (Years) Never smoked or not susceptible to smoke Stopped at age 45 Stopped at age 65 * Death due to irreversible chronic obstructive lung disease. Reprinted with permission from Fletcher C, Peto R. The natural history of chronic airflow obstruction. Br Med J. 1977;1(6077): } Ask patients about smoking to identify all candidates } Advise all tobacco users to quit } Assess the desire of the patient to quit } Assist in motivation and treatment } Arrange for follow-up and further smoking cessation monitoring Treating Tobacco Use and Dependence: 2008 Update Accessed 8/17/

15 } First-line Therapies Bupropion (Zyban, Wellbutrin ) Varenicline (Chantix ) Nicotine Replacement Therapies (NRT) Nicotine Patch (Nicoderm, Nicotrol, Habitrol, ProStep ) Nicotine Gum (Nicorette ) Nicotine Nasal Spray (Nicotrol NS ) Nicotine Inhaler (Nicotrol Inhaler ) Nicotine Lozenge (Commit Lozenge ) } Second-line Therapies Clonidine Nortriptyline } Combination Therapy Patch + ad lib NRT Patch + Buproprion SR Patch + nortriptyline Patch + Inhaler Patch + second generation antidepressant Treating Tobacco Use and Dependence:2008 Update Accessed 8/17/2012 } Initial visit reviewed inhaler technique, influenza vaccine given } Smoking cessation: Ready to stop smoking by 3rd visit (wants to live longer): Varenicline initated Developed strategies for stress: riding scooter, play with Ossy, chewing gum } 3 week follow-up smoking 1 cigarette per day } 4 week, 2 month, 6 month, 1 year post quit date not smoking!! } Chief complaints: coughing for one month, almost went to ER last night due to increasing shortness of breathe, been watching grandchildren and was exposed to pertussis } COPD: Diagnosed Quit smoking 2007 with 1 pack per day smoking history for many years. } COPD Medication: Albuterol inhaler 2 puffs every 6 hours PRN } Vaccinations: Tdap 2/2012, 10/2011 Influenza 15

16 } Comorbid conditions: Chronic pain, fibromyalgia, IBS, history of breast cancer, depression, anxiety, hypothyroidism, psoriasis } Spirometery: today FEV 1 64% predicted, FEV1/ FVC<0. 60; 2006 FEV 1 62% predicted } Xray=normal } Nasal swab: Negative for B. pertussis and B. parapertussis by PCR } Bronchodilators Beta 2 -agonists Anticholinergics Methylxanthines (not recommended as 1 st line) } Corticosteroids } Phosphodiesterase-4 inhibitors } Alpha-1 antitrypsin therapy } Antibiotics Not recommended except for treatment of infectious exacerbations and other bacterial infections } Mucolytic agents (Acetylcysteine/Mucomyst): Patients with viscous sputum may benefit from Overall benefits are very small Medication Class Short-Acting (SA) Anticholinergics Beta 2 -agonists Combination of beta 2 -agonist and anticholinergic Ipratropium (Atrovent HFA, nebs) Albuterol HFA (Proair, Ventolin, Proventil) Albuterol nebs, inhal soln Levalbuterol (Xopenex HFA, nebs) Pirbuterol (Maxair) Ipratropium+albuterol (Combivent, Duoneb, nebs) Long-Acting (LA) Tiotropium (Spiriva) Aclidinium (Tudorza Pressair) Salmeterol (Serevent) Formoterol (Foradil / Perforomist) Indacaterol (Arcapta Neohaler) Arformoterol (Brovana) None available 16

17 } Inhaled Corticosteroids (ICS) o Long term monotherapy not recommended o Beclomethasone, Budesonide, and Fluticasone o FEV 1 <60% predicted, symptoms, lung function, quality of life and frequency of exacerbations o Increases risk of pneumonia } Combination: ICS + Long Acting beta 2 -agonist o Fluticasone and Salmeterol (Advair ) o Budesonide and Formoterol (Symbicort ) More effective than single agents alone Increases risk of pneumonia } Systemic (long term treatment not recommended) } Addition of a long-acting beta 2 -agonist/inhaled glucorticosteroid combination to an anticholinergic (tiotropium) appears to provide additional benefits. } UPLIFT Trial: Addition of tiotropium in Stage II-III COPD (2987 vs 3006 controls); 72% using LABAs and/or ICS; 4 year study } Results Tiotropium therapy associated with improvements in lung function, quality of life, and exacerbations during a 4-year period but did not significantly reduce the rate of decline in FEV 1. Global Strategy for Diagnosis, Management and Prevention of COPD, (assessed 8/18/12) Tashkin DP, Celli B et al. A 4-year trial of tiotropium in chronic obstructive pulmonary disease. NEJM 2008; 359: } Phophodiesterase-4 Enzyme Inhibitor } Anti-inflammatory and bronchodilator activity } Reduce exacerbations for patients with chronic bronchitis, patients with FEV 1 < 50% of predicted and frequent exacerbations that are not adequately controlled by long acting bronchodilators } Dosing: 500mg once daily } Monitoring/Side effects GI side effects: diarrhea, nausea, abdominal pain CNS: Insomnia, depression and/or suicidal thoughts or behavior Weight loss Drug interactions with CYP3A4 drugs } Two, 12 month trials, roflumilast rate of moderate or severe exacerbations by 15% & 18% Product information for Daliresp. Forest Pharmaceuticals, Inc. St. Louis, MO Feb

18 } Spirometry is required to make a clinical diagnosis of COPD Classification of Severity of Airflow Limitation in COPD (Based on Post-Bronchodilator FEV1) GOLD 1 Mild FEV1 80% predicted GOLD 2 Moderate 50% FEV1 < 80% predicted GOLD 3 Severe 30% FEV1 < 50% predicted GOLD 4 Very Severe FEV1 < 30% predicted All conditions are in patients with FEV1/FVC < 0.7 Global Strategy for Diagnosis, Management and Prevention of COPD, (assessed 8/18/12) Patient Characteristic Spirometric Classification A B C D Low Risk Less Symptoms Low Risk More Symptoms High Risk Less Symptoms High Risk More Symptoms When assessing risk, choose the highest risk according to GOLD grade or exacerbation history Exacerbations per year mmrc CAT GOLD < 10 GOLD > 2 10 GOLD 3-4 > < 10 GOLD 3-4 > 2 > 2 Global Strategy for Diagnosis, Management and Prevention of COPD, (assessed 8/18/12) 10 COPD Assessment Test (CAT): An 8-item measure of health status impairment in COPD ( No permission to use in the USA. Modified Medical Research Counsel (mmrc) Dyspnea Questionnaire Dennis E. Doherty, MD, FCCP, Mark H. Belfer, DO, FAAFP, Stephen A. Brunton, MD Leonard Fromer, MD, Charlene M. Morris, MPAS, PA-C, Thomas C. Snader, PharmD, CGP, FASCP. Chronic Obstructive Pulmonary Disease: Consensus Recommendations for Early Diagnosis and Treatment. Journal of Family Practice, November,

19 Patient First Choice Second Choice Alternative A (Medication in each box are not necessarily in order of preference) SA anticholinergic PRN or SA beta2-agonist PRN LA anticholinergic or LA beta2-agonist or SA beta2-agonist/sa anticholinergic Theophylline B C D LA anticholinergic or LA beta2-agonist ICS + LA beta2-agonist or LA anticholinergic ICS + LA beta2-agonist or LA anticholinergic LA anticholinergic and LA beta2- agoinst LA anticholinergic and LA beta2- agonist ICS + LA anticholinergic or ICS + LA beta2-agonist + LA anticholinergic or ICS + LA beta2-agonist + PDE-4 inh. or LA anticholinergic + LA beta2- agonist or LA anticholinergic + PDE-4 inh. SA beta2 agonist and/or SA anticholinergic Theophylline PDE-4 Inh. SA beta2-agonist and/or SA anticholinergic Theophylline Carbocysteine SA beta2-agonist and/or SA anticholinergic Theophylline Adapted from Global Strategy for Diagnosis, Management and Prevention of COPD, (assessed 8/18/12) } Tiotropium inhaler initiated, reviewed inhaler technique, MD gave azithromycin. } 1 month later: reports breathing much better. Did not realize she had so much trouble breathing going up the stairs and how much things are improved. } Got a rash and went to the ER, thought it was the tiotropium. Started taking it every day for 1 week and then off for one week. } Actions: Reviewed COPD Action plan, inhaler technique, pneumoccol vaccination given. Recommend tiotropium daily. } Status/Post hospitalization for left upper lobe pneumonia, COPD exacerbation } Comorbid conditions: Rheumatoid arthritis steroid dependent, hyponatremia, Stage III pressure ulcer right heel, macrocytic anemia, weakness, dehydration, A fib, BPH, RLS } COPD Medications: Flucticasone/salmeterol disc 500/50 mg 1 inh twice daily, albuterol nebs 0.083% four times daily, albuterol inhaler 2 puffs q6 prn, tiotropium 1capsule inh once a day, prednisone taper down to 5mg once a day, oxygen 2 liters } Married, lives at home with wife. Discharged to skilled nursing facility. Smoker, currently on nicotine patch. Alcohol occasionally drinks. Vaccinations: pneumoccocal 2008, annual influenza 19

20 Assess and Educate on Inhaler Technique in Every Patient! Wieshammer, S., & Dreyhaupt, J. (2008). Dry powder inhalers: Which factors determine the frequency of handling errors. Respiration 2008; 75: Lareau SC and Hodder R. Teaching Inhaler use in chronic obstructive pulmonary disease patients. American Academy of Nurse Practitioners 2012; 24: } } Regimen including a long-acting bronchodilator and scheduled administration of short-acting bronchodilator Scheduled ipratroptium + tiotropium Scheduled albuterol + salmeterol/formoterol Regimen containing two corticosteroids Salmeterol/fluticasone inhaler + oral prednisone Budesonide nebs + oral dexamethasone Salmeterol/fluticasone + budesonide nebs COPD Onset in mid-life Symptoms slowly progressive Long smoking history Mono therapy: LABA/ Anticholinergic Do not use ICS alone ASTHMA Onset early in life (often childhood) Symptoms worse at night/early morning Symptoms vary from day to day Allergy, rhinitis, and/or eczema also present Family history of asthma Mono therapy: ICS Do not use LABA alone Vaccination: Influenza + Pneumovax Smoking Cessation Proper Inhaler Technique COPD/Asthma Action Plan 20

Provider Respiratory Inservice

Provider 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 information

Global 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 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 information

A Visual Approach to Simplifying Respiratory Drug Regimens

A Visual Approach to Simplifying Respiratory Drug Regimens A Visual Approach to Simplifying Respiratory Drug Regimens Stephanie Cheng, PharmD, MPH, BCGP 3 Main Categories Inhaled Respiratory Drugs Binds to beta-2 receptors Relaxation of smooth muscles in the lung

More information

Medications for Managing COPD in Hospice Patients. Jim Joyner, PharmD, CGP Director of Clinical Operations Outcome Resources

Medications for Managing COPD in Hospice Patients. Jim Joyner, PharmD, CGP Director of Clinical Operations Outcome Resources Medications for Managing COPD in Hospice Patients Jim Joyner, PharmD, CGP Director of Clinical Operations Outcome Resources Goal of medications in COPD Decrease symptoms and/or complications Reduce frequency

More information

Asthma medications: Know your options - MayoClinic.com. Asthma medications: Know your options

Asthma medications: Know your options - MayoClinic.com. Asthma medications: Know your options MayoClinic.com reprints This single copy is for your personal, noncommercial use only. For permission to reprint multiple copies or to order presentation-ready copies for distribution, use the reprints

More information

A Visual Approach to Simplifying Respiratory Drug Regimens

A Visual Approach to Simplifying Respiratory Drug Regimens A Visual Approach to Simplifying Respiratory Drug Regimens Stephanie Cheng, PharmD, MPH, BCGP October 23, 2017 Learning Objectives Be able to list at least 3 major adverse effects of inhaled medications

More information

A Visual Approach to Simplifying Respiratory Drug Regimens

A Visual Approach to Simplifying Respiratory Drug Regimens Adverse Effects of Inhaled Medications A Visual Approach to Simplifying Respiratory Drug Regimens Stephanie Cheng, PharmD, MPH, BCGP June 28, 2017 Drug Category Beta 2 agonists antagonists Adverse Effects

More information

Nancy Davis, RRT, AE-C

Nancy Davis, RRT, AE-C Nancy Davis, RRT, AE-C Asthma Statistics 25.6 million Americans diagnosed with asthma 6.8 million are children 10.5 million missed school days per year 14.2 lost work days for adults Approximately 10%

More information

II: Moderate Worsening airflow limitations Dyspnea on exertion, cough, and sputum production; patient usually seeks medical

II: Moderate Worsening airflow limitations Dyspnea on exertion, cough, and sputum production; patient usually seeks medical Table 3.1. Classification of COPD Severity Stage Pulmonary Function Test Findings Symptoms I: Mild Mild airflow limitations +/ Chronic cough and sputum production; patient unaware of abnormal FEV 1 80%

More information

COPD: Current Medical Therapy

COPD: 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 information

Asthma. Definition. Symptoms

Asthma. Definition. Symptoms Asthma Definition Asthma is a condition in which your airways narrow and swell and produce extra mucus. This can make breathing difficult and trigger coughing, wheezing and shortness of breath. For some

More information

MANAGING ASTHMA. Nancy Davis, RRT, AE-C

MANAGING ASTHMA. Nancy Davis, RRT, AE-C MANAGING ASTHMA Nancy Davis, RRT, AE-C What is asthma? Asthma is a chronic respiratory disease characterized by episodes or attacks of inflammation and narrowing of small airways in response to asthma

More information

Foundations of Pharmacology

Foundations of Pharmacology Pharmacologic Management of Asthma Objectives: 1. Review the physiological basis for asthma therapy 2. Discuss the differences between SABA and LABA 3. Discuss the role of inhaled and oral systemic corticosteroids

More information

Up 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 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 information

Inhaled bronchodilators relax constricted airways and treat the noisy part of asthma: coughing, wheezing, choking and shortness of breath.

Inhaled bronchodilators relax constricted airways and treat the noisy part of asthma: coughing, wheezing, choking and shortness of breath. Inhaled bronchodilators relax constricted airways and treat the noisy part of asthma: coughing, wheezing, choking and shortness of breath. AccuNeb inhalation 0.021% solution: 0.63mg/3mL 3-4 times solution

More information

Asthma in Pregnancy. Asthma. Chronic Airway Inflammation. Objective Measures of Airflow. Peak exp. flow rate (PEFR)

Asthma in Pregnancy. Asthma. Chronic Airway Inflammation. Objective Measures of Airflow. Peak exp. flow rate (PEFR) Chronic Airway Inflammation Asthma in Pregnancy Robin Field, MD Maternal Fetal Medicine Kaiser Permanente San Francisco Asthma Chronic airway inflammation increased airway responsiveness to a variety of

More information

Chronic Obstructive Pulmonary Disease

Chronic 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 information

Key features and changes to these four components of asthma care include:

Key features and changes to these four components of asthma care include: Guidelines for the Diagnosis and Management of Asthma in Adults Clinical Practice Guideline MedStar Health These guidelines are provided to assist physicians and other clinicians in making decisions regarding

More information

COPD. Breathing Made Easier

COPD. 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 information

Asthma By Mayo Clinic staff

Asthma By Mayo Clinic staff MayoClinic.com reprints This single copy is for your personal, noncommercial use only. For permission to reprint multiple copies or to order presentation-ready copies for distribution, use the reprints

More information

Improving Outcomes in COPD

Improving 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 information

ASTHMA IN THE PEDIATRIC POPULATION

ASTHMA IN THE PEDIATRIC POPULATION ASTHMA IN THE PEDIATRIC POPULATION SEARCH Rotation 2 August 23, 2010 Objectives Define asthma as a chronic disease Discuss the morbidity of asthma in pediatrics Discuss a few things that a health center

More information

Medications Affecting The Respiratory System

Medications Affecting The Respiratory System Medications Affecting The Respiratory System Overview Asthma is a chronic inflammatory disorder of the airways. It is an intermittent and reversible airflow obstruction that affects the bronchioles. The

More information

COPD 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 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 information

12/18/2017. Disclosures. Asthma Management Updates: A Focus on Long-acting Muscarinic Antagonists and Intermittent Inhaled Corticosteroid Dosing

12/18/2017. Disclosures. Asthma Management Updates: A Focus on Long-acting Muscarinic Antagonists and Intermittent Inhaled Corticosteroid Dosing Asthma Management Updates: A Focus on Long-acting Muscarinic Antagonists and Intermittent Inhaled Corticosteroid Dosing Diana M. Sobieraj, PharmD, BCPS Assistant Professor University of Connecticut School

More information

Women Beware-The Threat of COPD

Women Beware-The Threat of COPD Page 1 Speaker: Catherine Cooke attained her Bachelor in Pharmacy from the University of Iowa and then went on to receive her Pharm.D. from the Medical University of South Carolina. Subsequently, she completed

More information

Respiratory Health. Asthma and COPD

Respiratory 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 information

Diagnosis, Assessment, Monitoring and Pharmacological Treatment of Asthma

Diagnosis, Assessment, Monitoring and Pharmacological Treatment of Asthma Diagnosis, Assessment, Monitoring and Pharmacological Treatment of Asthma Magnitude of Asthma - India Delhi Childhood asthma: 10.9% Adults: 8% Other Cities 3 to 18% Chhabra SK et al Ann Allergy Asthma

More information

VA/DoD Clinical Practice Guideline Management of COPD Pocket Guide

VA/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 information

Asthma Management Updates: A Focus on Long-acting Muscarinic Antagonists and Intermittent Inhaled Corticosteroid Dosing

Asthma Management Updates: A Focus on Long-acting Muscarinic Antagonists and Intermittent Inhaled Corticosteroid Dosing Asthma Management Updates: A Focus on Long-acting Muscarinic Antagonists and Intermittent Inhaled Corticosteroid Dosing Diana M. Sobieraj, PharmD, BCPS Assistant Professor University of Connecticut School

More information

Allergies and Asthma 5/21/2013. Objectives. Allergic Rhinitis (AR): Risk Factor for ASTHMA. Rhinitis and Asthma

Allergies and Asthma 5/21/2013. Objectives. Allergic Rhinitis (AR): Risk Factor for ASTHMA. Rhinitis and Asthma Allergies and Asthma Presented By: Dr. Fadwa Gillanders, Pharm.D Clinical Pharmacy Specialist May 2013 Objectives Understand the relationship between asthma and allergic rhinitis Understand what is going

More information

Effective Date: 4/27/2016 Version: 1.0 Approval By: CCC Clinical Delivery Steering Planned Review Date: 4/27/2017

Effective Date: 4/27/2016 Version: 1.0 Approval By: CCC Clinical Delivery Steering Planned Review Date: 4/27/2017 Protocol Title: Adult Asthma Protocol Effective Date: 4/27/2016 Version: 1.0 Approval By: CCC Clinical Delivery Steering Planned Review Date: 4/27/2017 1 Purpose & Objective This protocol provides evidence-based

More information

Women Beware The Threat of COPD

Women Beware The Threat of COPD Page 1 Women Beware The Threat of COPD Catherine E. Cooke, PharmD, BCPS, PAHM President, PosiHealth, Inc. & Clinical Associate Professor, University of Maryland School of Pharmacy Supported by an education

More information

REVISED RESPIRATORY MEDICATION USE QUESTIONNAIRE

REVISED RESPIRATORY MEDICATION USE QUESTIONNAIRE REVISED RESPIRATORY MEDICATION USE QUESTIONNAIRE ID NUMBER: 0a) Date of Collection / / 0b) Staff Code Instructions: This form should be completed during the participant s clinic visit. 1) Are you regularly

More information

Assessing Severity. Management of Stable COPD. General Approach. Short Acting Bronchodilators. Staging System (GOLD)

Assessing 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 information

Better Living with Obstructive Pulmonary Disease A Patient Guide

Better Living with Obstructive Pulmonary Disease A Patient Guide Better Living with Obstructive Pulmonary Disease A Patient Guide Second Edition November 2012 Queensland Health a Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide is a joint project

More information

COPD 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 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 information

Asthma COPD Update 2018

Asthma COPD Update 2018 Asthma COPD Update 2018 Roger Hefflinger, Pharm.D. Clinical Associate Professor ISU COP Clinical Teaching Pharmacist Family Medicine Residency of Idaho In support of improving patient care, Idaho State

More information

TRELEGY ELLIPTA (fluticasone-umeclidinium-vilanterol) aerosol powder

TRELEGY ELLIPTA (fluticasone-umeclidinium-vilanterol) aerosol powder TRELEGY ELLIPTA (fluticasone-umeclidinium-vilanterol) aerosol powder Coverage for services, procedures, medical devices and drugs are dependent upon benefit eligibility as outlined in the member's specific

More information

Clinical Practice Guideline: Asthma

Clinical Practice Guideline: Asthma Clinical Practice Guideline: Asthma INTRODUCTION A critical aspect of the diagnosis and management of asthma is the precise and periodic measurement of lung function both before and after bronchodilator

More information

FASENRA (benralizumab)

FASENRA (benralizumab) FASENRA (benralizumab) Non-Discrimination Statement and Multi-Language Interpreter Services information are located at the end of this document. Coverage for services, procedures, medical devices and drugs

More information

Drugs that Affect the Respiratory System BROOKE BENTLEY, PHD, APRN

Drugs that Affect the Respiratory System BROOKE BENTLEY, PHD, APRN Drugs that Affect the Respiratory System BROOKE BENTLEY, PHD, APRN Goals of Therapy Asthma Prevent symptoms COPD Reduce COPD symptoms Decrease use of SABAs Maintain normal pulm function & prevent loss

More information

Learning Objective. Asthma. Discuss the pathophysiology, clinical presentation, diagnosis, and treatment of Asthma 2/22/2017

Learning Objective. Asthma. Discuss the pathophysiology, clinical presentation, diagnosis, and treatment of Asthma 2/22/2017 Marianne Curran, PA C 3/1/17 Learning Objective Discuss the pathophysiology, clinical presentation, diagnosis, and treatment of Definition many variations Chronic Disorder with Reversible (Intermittent

More information

Global 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 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 information

10/18/2012. Penn State University Children s Hospital JODIE STABINSKI CRNP MSN AE-C

10/18/2012. Penn State University Children s Hospital JODIE STABINSKI CRNP MSN AE-C Penn State University Children s Hospital JODIE STABINSKI CRNP MSN AE-C Daily: Long-Term Control Corticosteroids (inhaled and systemic) Long-acting beta 2 -agonists (Serevent, Foradil) Methylxanthines

More information

MEDICAL COVERAGE GUIDELINES ORIGINAL EFFECTIVE DATE: 07/05/18 SECTION: DRUGS LAST REVIEW DATE: LAST CRITERIA REVISION DATE: ARCHIVE DATE:

MEDICAL COVERAGE GUIDELINES ORIGINAL EFFECTIVE DATE: 07/05/18 SECTION: DRUGS LAST REVIEW DATE: LAST CRITERIA REVISION DATE: ARCHIVE DATE: CINQAIR (reslizumab) Non-Discrimination Statement and Multi-Language Interpreter Services information are located at the end of this document. Coverage for services, procedures, medical devices and drugs

More information

Asthma Description. Asthma is a disease that affects the lungs defined as a chronic inflammatory disorder of the airways.

Asthma Description. Asthma is a disease that affects the lungs defined as a chronic inflammatory disorder of the airways. Asthma Asthma Description Asthma is a disease that affects the lungs defined as a chronic inflammatory disorder of the airways. Symptoms of asthma In susceptible individuals, this inflammation causes recurrent

More information

STRIVERDI RESPIMAT (olodaterol hcl) aerosol

STRIVERDI 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 information

Incorporating Newer Therapies and Strategies to Improve COPD Outcomes: A Practical Guide for Pharmacists. Learning Objectives.

Incorporating Newer Therapies and Strategies to Improve COPD Outcomes: A Practical Guide for Pharmacists. Learning Objectives. Incorporating Newer Therapies and Strategies to Improve COPD Outcomes: A Practical Guide for Pharmacists Learning Objectives Identify the risk factors for COPD and the clinical features that differentiate

More information

COPD. Definitionn. make. when (bronchioles) in. the lungs. Wheezing Chest tightness. your lungs. greenish. Lack of energy

COPD. Definitionn. make. when (bronchioles) in. the lungs. Wheezing Chest tightness. your lungs. greenish. Lack of energy COPD Definitionn Emphysema and chronic bronchitis are the two most common conditions thatt make up COPD. Chronic bronchitis is an inflammation of the lining of your bronchial tubes, which carry air to

More information

Disclosure and Conflict of Interest 8/15/2017. Pharmacist Objectives. At the conclusion of this program, the pharmacist will be able to:

Disclosure 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 information

Ferris State University College of Pharmacy MPA CE Symposium 2016 Paul Thill, PharmD, BCPS

Ferris State University College of Pharmacy MPA CE Symposium 2016 Paul Thill, PharmD, BCPS Ferris State University College of Pharmacy MPA CE Symposium 2016 Paul Thill, PharmD, BCPS Objectives Categorize the new asthma and COPD inhalers in to existing or newly created categories Discuss the

More information

Staying Healthy. with Asthma. Illustrations by paulsharp.com

Staying Healthy. with Asthma. Illustrations by paulsharp.com Staying Healthy with Asthma Illustrations by paulsharp.com Lungs & Asthma What is Asthma? Inflammation or swelling of airways that leads to: 1) Mucous production deep inside the airways. 2) Temporary difficulty

More information

Clinical Guideline for the Diagnosis, Evaluation, and Management of Adults and Children with Asthma

Clinical Guideline for the Diagnosis, Evaluation, and Management of Adults and Children with Asthma Clinical Guideline for the Diagnosis, Evaluation, and Management of Adults and Children with Asthma - 2005 Criteria that suggest the diagnosis of Asthma: The symptoms of dyspnea, cough and/or wheezing,

More information

COPD: A Renewed Focus. Disclosures

COPD: A Renewed Focus. Disclosures COPD: A Renewed Focus Heath Latham, MD Assistant Professor Division of Pulmonary and Critical Care Medicine Disclosures No Business Interests No Consulting No Speakers Bureau No Off Label Use to Discuss

More information

What You Need to Know about Metered-Dose Inhalers and the HFA Propellant

What You Need to Know about Metered-Dose Inhalers and the HFA Propellant What You Need to Know about Metered- Inhalers and the HFA Propellant There are a number ways to deliver inhaled medication. They include: Metered-dose inhaler () Metered-dose inhaler with spacer/holding

More information

COPD: Preventable and Treatable. Lecture Outline. Diagnosis of COPD. COPD: Defining Terms

COPD: 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 information

End Stage COPD Guidance Document

End Stage COPD Guidance Document End Stage COPD Guidance Document Suggested Guidelines for the Determination of Hospice Eligibility A patient with severe chronic pulmonary disease that meets the following criteria may be eligible for

More information

31 - Respiratory System

31 - Respiratory System 31 - Respiratory System Asthma 1. Asthma has two components. Name the two components. 2. What are the common triggers of asthma? (LP p319) (e.g., pets) Upper respiratory infections ( ) 3. Describe a normal

More information

Respiratory Medications and Devices Update 2/15

Respiratory Medications and Devices Update 2/15 Respiratory Medications and Devices Update 2/15 Dewey Hahlbohm, PA-C, AE-C Wendy Brown, Pharm.D., MPAS, PA-C, AE-C Objectives! Review mechanism of action for asthma pharmacologic agents! Describe key patient

More information

Adult Asthma Clinical Practice Guideline Summary

Adult Asthma Clinical Practice Guideline Summary Adult Asthma Clinical Practice Guideline Summary The following evidence-based guideline was developed to assist Primary Care physicians and other clinicians in the management of asthma in adults. It was

More information

ASTHMA BEST PRACTICES FOR SCHOOL NURSES. School Nurses November 2015

ASTHMA BEST PRACTICES FOR SCHOOL NURSES. School Nurses November 2015 ASTHMA BEST PRACTICES FOR SCHOOL NURSES School Nurses November 2015 1 BACKGROUND AND CURRENT STATS General definitions and explanations 2 Incidence of Asthma Centers for Disease Control (CDC) - 1 in 12

More information

Presented by UIC College of Nursing

Presented 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 information

Chronic Obstructive Pulmonary Disease 1/18/2018

Chronic 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

Drug Class Monograph

Drug Class Monograph Drug Class Monograph Class: Inhaled Corticosteroids Drugs: Aerospan (flunisolide), Advair Diskus, Advair HFA (fluticasone/salmeterol), Alvesco (ciclesonide), Arnuity Ellipta (fluticasone furoate), Asmanex

More information

Disclosure. Case. Objectives. Case Continued. Inhalers. Asthma: A GINA Update to the NAEPP 2007 Guidelines 1/20/2015

Disclosure. Case. Objectives. Case Continued. Inhalers. Asthma: A GINA Update to the NAEPP 2007 Guidelines 1/20/2015 Disclosure Asthma: A GINA Update to the NAEPP 2007 Guidelines Robert (RC) Hellinga, Pharm.D. PGY 1 Pharmacy Resident Wolfson Children s Hospital/Baptist Health I do not have a vested interest in or affiliation

More information

THE CHALLENGES OF COPD MANAGEMENT IN PRIMARY CARE An Expert Roundtable

THE 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 information

2/4/2019. GOLD Objectives. GOLD 2019 Report: Chapters

2/4/2019. 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 information

COPD. Stan Kellar, MD. Physiology 11/4/2014. Chief of Clinical Affairs, BH NLR Pulmonary Medicine Sleep Medicine

COPD. 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 information

Advances 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 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 information

Breathe Easy. Living with Asthma

Breathe Easy. Living with Asthma Breathe Easy Living with Asthma Got Asthma? You re Not Alone! More than 300 million people around the world have asthma. But having asthma doesn t have to limit what you can do. With education and treatment,

More information

COPD. Diseases and Conditions

COPD. Diseases and Conditions Diseases and Conditions COPD By Mayo Clinic Staff Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease that causes obstructed airflow from the lungs. Symptoms include breathing

More information

How to treat COPD? What is the mechanism of dyspnea? Smoking cessation

How 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 information

Inhaled Corticosteroids Drug Class Prior Authorization Protocol

Inhaled Corticosteroids Drug Class Prior Authorization Protocol Inhaled Corticosteroids Drug Class Prior Authorization Protocol Line of Business: Medi-Cal P&T Approval Date: February 21, 2018 Effective Date: April 1, 2018 This policy has been developed through review

More information

Asthma in the Athlete

Asthma in the Athlete Asthma in the Athlete Jorge E. Gomez, MD Associate Professor Texas Children s Hospital Baylor College of Medicine Assist Team Physician UH Understand how we diagnose asthma Objectives Be familiar with

More information

Inhaled Corticosteroids Drug Class Prior Authorization Protocol

Inhaled Corticosteroids Drug Class Prior Authorization Protocol Inhaled Corticosteroids Drug Class Prior Authorization Protocol Line of Business: Medicaid P&T Approval Date: February 21, 2018 Effective Date: April 1, 2018 This policy has been developed through review

More information

Asthma Medications: Information for Children and Families. What You Need to Know about Medicines for Asthma

Asthma Medications: Information for Children and Families. What You Need to Know about Medicines for Asthma Page 1 of 8 PED-ALL-005-1992 Asthma Medications: Information for Children and Families What You Need to Know about Medicines for Asthma What Medicines Are used to Treat Asthma? There are two kinds of medicines:

More information

How can I benefit most from my COPD medications?

How 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 information

Chronic Obstructive Pulmonary Disease

Chronic 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 information

Three s Company - The role of triple therapy in chronic obstructive pulmonary

Three 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 information

Asthma ASTHMA. Current Strategies for Asthma and COPD

Asthma ASTHMA. Current Strategies for Asthma and COPD Current Strategies for Asthma and COPD Talmadge E. King, Jr., M.D. Krevins Distinguished Professor of Medicine Chair, Department of Medicine University of California San Francisco (UCSF) San Francisco,

More information

Learning Objectives 4/26/2012. Review normal lung function and COPD pathophysiology Discuss pharmacological management

Learning Objectives 4/26/2012. Review normal lung function and COPD pathophysiology Discuss pharmacological management Marliese Gibson PharmD HospiScript, a Catalyst Rx Company May 16, 2012 Chronic Obstructive Pulmonary Disease Learning Objectives Review normal lung function and COPD pathophysiology Discuss pharmacological

More information

UPMC HEALTH PLAN COPD CLINICAL PRACTICE GUIDELINE

UPMC HEALTH PLAN COPD CLINICAL PRACTICE GUIDELINE Relevance to Population: COPD affects 12 million people in the United States, making it the 4 th leading cause of mortality and the 2 nd leading cause of disability. It is predicted that these statistics

More information

Bronchiectasis. Examples include: Viral infections (measles, adenovirus, influenza)

Bronchiectasis. Examples include: Viral infections (measles, adenovirus, influenza) Bronchiectasis What is Bronchiectasis? Bronchiectasis (pronounced bron-kee-ek'-tas-is) is a condition of the airways in the lungs. These airways (bronchial tubes) are tubelike structures that branch from

More information

GINA. At-A-Glance Asthma Management Reference. for adults, adolescents and children 6 11 years. Updated 2017

GINA. At-A-Glance Asthma Management Reference. for adults, adolescents and children 6 11 years. Updated 2017 GINA At-A-Glance Asthma Management Reference for adults, adolescents and children 6 11 years Updated 2017 This resource should be used in conjunction with the Global Strategy for Asthma Management and

More information

Balanced information for better care. Helping patients with COPD breathe easier

Balanced information for better care. Helping patients with COPD breathe easier Balanced information for better care Helping patients with COPD breathe easier COPD is the third-leading cause of death in the U.S., following cancer and heart disease 1 FIGURE 1. Women now have a higher

More information

COPD/Asthma. Prudence Twigg, AGNP

COPD/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 information

Using Inhaled Corticosteroids as Needed for Asthma: giving patients relief or leaving them breathless?

Using Inhaled Corticosteroids as Needed for Asthma: giving patients relief or leaving them breathless? Using Inhaled Corticosteroids as Needed for Asthma: giving patients relief or leaving them breathless? Lindsay Thomas, Pharm.D. PGY2 Ambulatory Care Resident Department of Pharmacotherapy and Pharmacy

More information

Pediatric Asthma Management

Pediatric Asthma Management Pediatric Asthma Management APRN Conference February 2016 Cheryl Kerrigan, MSN, CPNP Aimee Tiller RN, AE-C The Plan Definition Pathophysiology review Triggers & Risk Factors Incidence and Prevalence Making

More information

ANTINEOPLASTIC DRUGS CHAPTER 21. Antineoplastic drugs - designed to treat malignancies, now also used to treat diseases with inflammatory component

ANTINEOPLASTIC DRUGS CHAPTER 21. Antineoplastic drugs - designed to treat malignancies, now also used to treat diseases with inflammatory component ANTINEOPLASTIC DRUGS CHAPTER 21 Antineoplastic drugs - designed to treat malignancies, now also used to treat diseases with inflammatory component Tx of malignancies Antineoplastic drugs: methotrexate

More information

Alberta Childhood Asthma Pathway for Primary Care

Alberta Childhood Asthma Pathway for Primary Care Asthma Diagnosis Box 1 Diagnosis: Based on symptom pattern, careful and thorough history of symptoms (wheeze, cough, night waking and activity limitations), and assessment of family history of asthma and

More information

1 I *********IF YOU ARE NOT ON ALLERGY SHOTS PLEASE SKIP THIS SECTION AND MOVE TO PAGE 2********* NAME: AGE: ---- ID (For Office Use Only):

1 I *********IF YOU ARE NOT ON ALLERGY SHOTS PLEASE SKIP THIS SECTION AND MOVE TO PAGE 2********* NAME: AGE: ---- ID (For Office Use Only): NAME: AGE: ---- Date of Appointment:. ID (For Office Use Only): RETURN VISIT Date of Visit: Main Reason for visit: Reevaluation Family Doctor: Symptoms worse _ New problem _ Yearly follow up _ Follow up/office

More information

Integrated Cardiopulmonary Pharmacology Third Edition

Integrated Cardiopulmonary Pharmacology Third Edition Integrated Cardiopulmonary Pharmacology Third Edition Chapter 13 Pharmacologic Management of Asthma, Chronic Bronchitis, and Emphysema Multimedia Directory Slide 7 Slide 12 Slide 60 COPD Video Passive

More information

Chronic Obstructive Pulmonary Disease (COPD) Clinical Guideline

Chronic 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 information

Function of the Respiratory System. Exchange CO2 (on expiration) for O2 (on inspiration)

Function of the Respiratory System. Exchange CO2 (on expiration) for O2 (on inspiration) Function of the Respiratory System Exchange CO2 (on expiration) for O2 (on inspiration) Upper Respiratory Tract Includes: Nose Mouth Pharynx Larynx Function: Warms and humidifies the inspired air Filters

More information

ASTHMA-COPD OVERLAP SYNDROME 2018: What s All the Fuss?

ASTHMA-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 information

Primary Care Medicine: Concepts and Controversies Wed., February 17, 2010 Fiesta Americana Puerto Vallarta, Mexico Update on Asthma and COPD

Primary Care Medicine: Concepts and Controversies Wed., February 17, 2010 Fiesta Americana Puerto Vallarta, Mexico Update on Asthma and COPD Primary Care Medicine: Concepts and Controversies Wed., February 17, 2010 Fiesta Americana Puerto Vallarta, Mexico Update on Asthma and COPD Talmadge E. King, Jr., M.D. Krevins Distinguished Professor

More information

MANAGEMENT OF ASTHMA SPRING Presented by:

MANAGEMENT OF ASTHMA SPRING Presented by: MEDS@Work MANAGEMENT OF ASTHMA SPRING 2013 Presented by: Lusia Fomuso PharmD candidate 2014 Olivia Sibailly PharmD candidate 2014 Kimberly Biedka PharmD candidate 2014 Dr. Donna Bartlett PharmD CGP RPh

More information

2/12/2015. ASTHMA & COPD The Yin &Yang. Asthma General Information. Asthma General Information

2/12/2015. ASTHMA & COPD The Yin &Yang. Asthma General Information. Asthma General Information ASTHMA & COPD The Yin &Yang Arizona State Association of Physician Assistants March 6, 2015 Sedona, Arizona Randy D. Danielsen, PhD, PA-C, DFAAPA Dean & Professor A.T. Still University Asthma General Information

More information

(pedi) Patient Name: date of birth:

(pedi) Patient Name: date of birth: (pedi) Patient Name: date of birth:_ Date: I am being seen on: a) self referral _ b) physician referral from Dr. Please share the main reasons for your office visit today (check all those that apply):

More information