Women Beware The Threat of COPD
|
|
- Samuel Dalton
- 5 years ago
- Views:
Transcription
1 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 grant from Boehringer Ingelheim Women Beware The Threat of COPD 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 a specialty residency in Ambulatory Care/Managed Care through the Philadelphia College of Pharmacy and Science. After post-graduate training, Dr. Cooke served as a full-time Assistant Professor at the University of Maryland School of Pharmacy where she became a Board Certified Pharmacotherapy Specialist. Currently, she is an Independent Consultant working in health care quality and research. In addition, she provides clinical pharmacy services such as hypertension, dyslipidemia and smoking cessation management to patients in Maryland. Her main research interests are in the areas of cardiovascular pharmacotherapeutics and pharmacy services in the managed care environment with specific interest in discrepancies in health care based on sex or ethnicity. Speaker Disclosure: Dr. Cooke has no actual or potential conflicts of interest in relation to this program Supported by an education grant from Boehringer Ingelheim PharmCon is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education Accreditation: Pharmacists L01-P Pharmacy Technicians L01-T Target Audience: Pharmacists & Technicians Women Beware The Threat of COPD CE Credits: 1.0 Continuing Education Credit or 0.1 CEU for pharmacists/technicians Expiration Date: 05/27/2012 Program Overview: Women have made a good deal of welcome progress in the last several decades, but at least one advance is unwanted: chronic obstructive pulmonary disease (COPD) is on the rise in women in prevalence, morbidity and mortality. By 2000, the number of women dying from COPD surpassed the number of men. But the rising number of cases in women has not been matched by medical understanding of the disease's apparent gender-bias. This program will increase the awareness of COPD in women. The program will focus on the pharmacists role in identifying patients with COPD (women in particular), reducing the risk factors for developing COPD (such as smoking cessation), and managing the disease. Objectives: Review the etiology and epidemiology of chronic obstructive pulmonary disease (COPD) in women. Identify the impact of COPD on women and the differences in how the disease manifests itself in women compared to men. Provide an update on the efficacy, safety, and role of available treatments in the management of COPD. Describe how pharmacist s can play a critical role in COPD identification, management and education (particularly with women). Supported by an education grant from Boehringer Ingelheim Learning REVIEW the etiology Objectives and epidemiology of chronic obstructive pulmonary disease (COPD) in women. IDENTIFY the impact of COPD on women and the differences in how the disease manifests itself in women compared to men. PROVIDE an update on the efficacy, safety, and role of available treatments to manage COPD. DESCRIBE how pharmacist s can play a critical role in COPD identification, management and education (particularly with women). PharmCon is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education
2 Page 2 Chronic obstructive pulmonary disease (COPD) Characterized by airflow limitation Not fully reversible Usually progressive Used to be looked upon as 2 diseases chronic bronchitis and emphysema but usually conditions coexist Chronic bronchitis Bronchial tubes are inflamed and eventually scarred Emphysema Alveoli are irreversibly damaged and lose elasticity 1. Rennard SI. COPD: overview of definitions, epidemiology, and factors influencing its development. Chest 1998;113(Suppl 4): s. COPD Asthma Age of onset Usually >40 years Any age (usually < 40 years) Smoking History Symptom Pattern Airway Reversibility Steroid response in stable disease Usually > 20 packyears Usually chronic, slowly progressive Partially reversible Unusual (~15% - 20%) Unrelated Varies day by day Nocturnal/early morning Largely reversible Present Clinical Presentation of COPD Symptoms Chronic cough Sputum production Shortness of breath leading to chronic fatigue, decreased exercise capacity and increased respiratory exacerbations Consequences Respiratory failure Cor pulmonale (right sided heart failure) Respiratory exacerbations become life-threatening Spirometry Lung function reported as percent of predicted values for a normal population Terminology FEV 1 = forced expiratory volume in 1 second FVC = forced vital capacity
3 Liters Page 3 COPD Defining Characteristics Spirometric diagnostic criteria Reduced forced expiratory volume in 1 second FEV 1 < 80% Spirometry: Volume/Time Curve 1 2 FEV 1 Normal 4.15 COPD FEV 1 FVC FEV 1 / FVC 5.2 > 80% < 70% Reduced ratio of FEV 1 to FVC 3 COPD FEV 1 /FVC < 70% 4 FEV 1 FVC 5 Normal FVC Seconds Diagnosis of COPD in Women Diagnosis of COPD in Women 80 Spirometry % Diagnosed Clinical presentation Spirometry Primary care physicians underutilize spirometry Women less likely to receive referrals to specialists than men Study: Confronting COPD Survey Women less likely to have spirometry than men (OR 0.84; 95% CI ) Female case Male case
4 Number Deaths x 1000 Page 4 Epidemiology Estimated 24 million adults with COPD in US COPD Mortality by Gender, U.S., COPD - 4 th leading cause of death in the US 1 Hospitalization: Hospitalization rates greater for women than men since 1993 Mortality worse in women 1. National Center for Health Statistics. Deaths: final data for Hyattsville, MD: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. National Vital Statistics Report 2001;49: American Lung Association Epidemiology and Statistics Unit Research and Program Services. Trends in COPD(Chronic Bronchitis and Emphysema); Morbidity and Mortality. American Lung Association Website. Accessed march 14 th, Men Women US Centers for Disease Control and Prevention, 2002 Risk Factors - Smoking Tobacco use is the #1 cause of COPD 1 75% of deaths from COPD resulted from smoking in 2005 Cigarette smokers vs. nonsmokers 2 Greater annual decrease in FEV1 More respiratory symptoms Higher death rates Women more susceptible to smoke? Meta-analysis: Women who smoke had significantly faster annual decline in FEV1% predicted with increasing age vs. men who smoke Lung Health Study Increase in # of cigarettes resulted in larger decline in FEV1 than men Why? 1. Centers for Disease Control and Prevention (CDC). Deaths from chronic obstructive pulmonary disease--united States, [Journal Article] MMWR - Morbidity & Mortality Weekly Report. 57(45): , 2008 Nov American Lung Association Epidemiology and Statistics Unit Research and Program Services. Trends in COPD(Chronic Bronchitis and Emphysema); Morbidity and Mortality. American Lung Association Website. Accessed march 14 th, 2009.
5 Page 5 Other Risk Factors Genetic severe heredity deficiency of alpha-1 antitrypsin Occupational dust and chemicals Pollution indoor (biomass cooking) and outdoor (urban pollution) Infection severe childhood respiratory infection Women who smoke during pregnancy decrease lung growth in utero 1. American Lung Association Epidemiology and Statistics Unit Research and Program Services. Trends in COPD (Chronic Bronchitis and Emphysema): Morbidity and Mortality. American Lung Association Website. Accessed March 14 th, Consensus Guidelines GOLD Global Initiative for Chronic Obstructive Lung Disease 1 US National Heart, Lung and Blood Institute and World Health Organization joint committee First published in 2001 Last revision published 2008 Covers diagnosis, management and prevention Does not differentiate diagnosis and management between men 1. National and Heart, Lung, women and Blood Institute and World Health Organization. Global initiative for chronic obstructive lung disease: global strategy for diagnosis, management, and prevention of chronic obstructive pulmonary disease update. Available at: Accessed March 15 th,2009. Treatment Pathway Consensus Guidelines - Diagnosis I: Mild COPD FEV1/FVC < 70% FEV1 >= 80% predicted II: Moderate COPD FEV1/FVC < 70% 50% <= FEV1 < 80% predicted III: Severe COPD FEV1/FVC < 70% 30% <= FEV1 < 50% predicted IV: Very Severe COPD FEV1/FVC < 70% FEV1 <30% predicted or FEV1< 50% predicted plus chronic respiratory failure (Respiratory Failure: arterial partial pressure of oxygen PaO2 less than 60mmHg with or without PaCO2 greater than 50mmHg 1. Pauwels et. Al. Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive lung Disease (GOLD) Workshop summary. Am J Respir Crit Care Med Apr;163(5):
6 Page 6 Non Pharmacologic Therapy Smoking Cessation Vaccines Flu: Annual influenza vaccine Pneumococcal polysaccharide vaccine Age 65 or older <65 years and FEV1 <40% predicted
7 Page 7 Broncholilators Central to symptomatic management PRN or scheduled based on severity Inhaled route preferred fewer adverse effects Includes: β2- agonists, anticholinergics and methylxanthines All increase exercise capacity Long-acting forms more effective and convenient Short Acting β2- agonists Medication Brand Generic Availability Dosage FDA approval Directions Class Form Bronchodilator- Proventil Albuterol Brand only Inhaler No -asthma, 2 inhalationsevery 4 6 Short acting B2- bronchitis hours agonist Ventolin Albuterol Brand only Inhaler No -asthma 2 inhalations every 4 6 hours Proair Albuterol Brand only Inhaler No -asthma 2 inhalations every 4 6 hours Xopenex levalbuterol Brand only Inhaler No - asthma 2 inhalations every 4 6 hours Maxair Pirbuterol Brand only Inhaler Yes 2 inhalations every 4 6 hours Class Side Brethine Terbutaline Generic only Tablets Yes, also asthma 5 mg PO three times daily Effects: dry mouth, irritated Alupent Metaproterenol Generic only nebulizing Yes ml of 5% (10 15 throat, trembling, solution mg) solution, diluted in 2.5 nervousness, 3 ml of 1/2 NS, NS, or other dizziness, diluents or, 2.5 ml of 0.4 headache, 0.6% solution (10 15 mg). palpitations, Doses may be repeated 3 4 nausea, vomiting times per day mg initially Accuneb Albuterol solution Generic only nebulizing No -asthma, every 20 solution bronchitis minutes for 3 doses, then mg every 1 4 hours as needed
8 Page 8 Long Acting β2- agonists Anticholinergics Medication Class Brand Generic Availability Dosage Form FDA approval Directions Medication Class Brand Generic Availability Dosage Form FDA approval Directions Bronchodilator- Long acting B2- agonist Foradil Formoterol Brand only Aerolizer Yes, also asthma Inhale 12 mcg (contents of one capsule) every 12 hours using the Aerolizer Anitcholinergics- Atrovent ipratropium Brand only Inhaler Yes, also asthma 2 sprays (18 mcg/spray) Short and long 3 4 times per day acting Serevent Salmeterol Brand only Diskus Yes, also asthma 50 mcg (1 oral inhalation) of salmeterol twice daily Class Side Effects: dry mouth, irritated throat, trembling, Perforomist Formoterol Brand only Nebulizing Yes, also asthma One 20 mcg unit dose nervousness, solution vial administered by dizziness, nebulization twice daily in headache, the morning and evening palpitations, nausea, vomiting Class Side Spiriva tiotropium Brand only Handihaler Yes 18 mcg once per day via Effects: oral inhalation Dry mouth, blurred vision, Ipitropiuim ipratropium Generic only Nebulizing Yes, also asthma 500 mcg (1 unit dose vial) constipation, runny solution solution 3 4 times per day via nose, irritated oral nebulization throat, runny nose, AntiCholinergics & CV Risk? Theophylline Meta-Analysis to assess CV risks associated with >30 day use of ipratropium and tiotropium vs. control in patients with COPD 17 RCT with 7472 on anticholinergics and 7311 on control Results: Inhaled anticholinergics significantly increased: Risk of CV death, non-fatal MI or stroke, RR 1.58 (95% CI, ) MI, RR 1.53, (95% CI ) CV death, RR 1.80 (95% CI ) Stroke NOT significantly increased Secondary outcome - risk of all-cause mortality NS difference Need prospective RCT to accurately access CV risk Low dose theophylline reduces exacerbations but does not increase post-bronchodilator lung function Higher does are effective bronchodilators, but may cause toxicity Theophylline Dosing 150mg BID increase to 200mg BID after 3 days, Then 300mg BID after 3 days or QD then mg QD Titrate according to blood level
9 Page 9 Steroids Regular treatment does not modify long term decline Increases likelihood of pneumonia, does not decrease mortality Reduce exacerbations in Severe COPD and Very Severe COPD FEV1<50% predicted If needed, combination products with anticholinergic synergistic Inhaled Steroids Medication Class Inhaled Corticosteroids Class Side Effects: dry mouth, hoarseness, throat infection, oral candidiasis Brand Generic Availability Dosage Form FDA approval Directions Qvar beclomethasone Brand only Inhaler No - asthma mcg (1 2 sprays) inhaled orally twice daily Pulmicort budesonide Brand only Flexhaler No - asthma 360 mcg twice daily by oral inhalation Pulmicort budesonide Brand/Generic Nebulizing No - asthma For children: 0.5 mg/day Respules solution inhaled via jet nebulizer either once daily or divided into 2 doses Flovent fluticasone Brand only Diskus Yes, also asthma 1 inhalation twice daily Alvesco Ciclesonide Brand only Inhaler No, asthma, allergies 1 inhalation twice daily Asmanex Brand only Twisthaler No, asthma 1 inhalation twice dialy Azmacort triamcinolone Brand only Inhaler No - asthma Initially, 150 mcg (2 inhalations) PO 3 4 times per day or 300 mcg (4 inhalations) PO twice daily. Aerobid flunisolide Brand only Inhaler No- asthma 2 sprays (250 mcg/spray) via oral inhalation twice daily Combination Products Brand Generic Availability Dosage Form FDA approval Directions Combivent albuterol/ipratropium Brand only Inhaler Yes, also asthma Inhale 2 actuations four times per day Advair salmeterol/fluticasone Brand only Diskhaler Yes, also asthma 1 inhalation twice a day Duoneb albuterol/ipratropium Brand/generic Nebulizing solution Yes, also asthma Inhale one 3 ml vial via nebulizer four times per day Symbicort budesonide/formoterol Brand only Inhaler Yes, also asthma 2 inhalations of Symbicort 160/4.5 (160 mcg of budesonide and 4.5 mcg of formoterol per inhalation) twice daily Pharmacist s Role Inquire about and recommend spirometry Smoking cessation counseling at every visit Nutrition counseling Preventing infections hand washing, vaccinations Recognizing exacerbations Education Depression and anxiety screening Support groups
10 Page 10 Pharmacist s Role Training patients to use inhalers is crucial 1 : 1. Mourad RE, Hagerman JK. Management Strategies in Stable COPD. US Pharmacist.2009;34-HS-10-HS-18. Jan yo woman visits PCP for a lingering cough after having a cold Subjective: CC: I ve been recovering from a cold, but the cough is getting worse even though my nose is not running anymore. Sometimes the cough is so bad that it keeps me awake at night. HPI: MF recovered from a cold 1 month ago, but still suffers from a cough with sputum. Patient has had a chronic cough since she quit smoking 5 years ago, but lately it is getting worse. Cough worsens with exercise and during the winter months. PMH: Tobacco dependence for 35 years, smoke-free for 5 years, HTN, Seasonal allergies 66 yo woman visits PCP for a lingering cough after having a cold 66 yo woman visits PCP for a lingering cough after having a cold Objective: Medications: Amlodipine 10mg PO QAM HCTZ 25 mg PO QAM Nasonex 2 sprays in each nostril QD during allergy season Claritin D PO QD during allergy season PE: General- Overweight female coughing with clear sputum. VS: BP138/85, P 110, RR 22, Wt 70kg, Ht 5 4, T 37 degrees, O2 sat 90% Diagnosis: CXR - Normal Spirometry - FEV1 = 0.65, FEV1/FVC= 76% (Referral to pulmonologist) Assessment: 1) Undiagnosed Stage II moderate COPD - uncontrolled 2) HTN - controlled 3) Seasonal allergic rhinitis - controlled
11 Page 11 Stage II moderate COPD - uncontrolled Conclusion Plan: Educate patient about disease and disease progression Pharmacologic regimen: Start short-acting beta-agonist inhaler PRN and tioptropium inhalation QD Education patient on inhaler technique Re-evaluate in 1 month Schedule for influenza (seasonal) and pneumococcal vaccinations Improve diagnosis of COPD in women (increased suspicion, spirometry, referral to specialist) Education: Prevention Smoking Women at higher risk Management: Smoking cessation (with increased attention to preventing relapse) Vaccines Pharmacotherapy Use therapies based on severity of COPD Notes Notes
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 informationCOPD. Breathing Made Easier
COPD Breathing Made Easier Catherine E. Cooke, PharmD, BCPS, PAHM Independent Consultant, PosiHleath Clinical Associate Professor, University of Maryland School of Pharmacy This program has been brought
More informationA 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 informationA 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 informationA 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 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 informationII: Moderate Worsening airflow limitations Dyspnea on exertion, cough, and sputum production; patient usually seeks medical
Table 3.1. Classification of COPD Severity Stage Pulmonary Function Test Findings Symptoms I: Mild Mild airflow limitations +/ Chronic cough and sputum production; patient unaware of abnormal FEV 1 80%
More 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 informationInhaled 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 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 informationMedications 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 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 information12/18/2017. Disclosures. Asthma Management Updates: A Focus on Long-acting Muscarinic Antagonists and Intermittent Inhaled Corticosteroid Dosing
Asthma Management Updates: A Focus on Long-acting Muscarinic Antagonists and Intermittent Inhaled Corticosteroid Dosing Diana M. Sobieraj, PharmD, BCPS Assistant Professor University of Connecticut School
More informationTRELEGY 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 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 informationAsthma Management Updates: A Focus on Long-acting Muscarinic Antagonists and Intermittent Inhaled Corticosteroid Dosing
Asthma Management Updates: A Focus on Long-acting Muscarinic Antagonists and Intermittent Inhaled Corticosteroid Dosing Diana M. Sobieraj, PharmD, BCPS Assistant Professor University of Connecticut School
More informationCOPD. Helen Suen & Lexi Smith
COPD Helen Suen & Lexi Smith What is COPD? Chronic obstructive pulmonary disease: a non reversible, long term lung disease Characterized by progressively limited airflow and an inability to perform full
More informationAsthma 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 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 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. 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 informationRespiratory Health. Asthma and COPD
Respiratory Health Asthma and COPD Definition of asthma Working definition by AAH 2014: Chronic lung disease Can be controlled not cured Large variation in lung function Large variation in respiratory
More informationMedications 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 informationChronic Obstructive Pulmonary Disease
Chronic Obstructive Pulmonary Disease CareOregon Pharmacy Abridged sample of presentation content Home Equipment Pathophysiology Exacerbations Guidelines Lifestyle Modification Medication Management Sample
More informationFoundations 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 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 informationAssessing Severity. Management of Stable COPD. General Approach. Short Acting Bronchodilators. Staging System (GOLD)
William P. Saliski Jr. DO Montgomery Pulmonary Consultants Management of Stable COPD Pharmacotherapy Oxygen Smoking Cessation Vaccinations Rehabilitation Surgery Future Discussions Assessing Severity Staging
More informationPeople with asthma who smoke. The combination of asthma, a chronic airway disease, and smoking increases the risk of COPD even more.
COPD Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease that causes obstructed airflow from the lungs. Symptoms include breathing difficulty, cough, sputum (phlegm) production
More informationDiagnosis and Management of Asthma
Supporting Evidence: Diagnosis and Management of Asthma The subdivision of this section is: Appendix B Tables Copyright 2016 by 1 Eleventh Edition/December 2016 Appendix B Asthma Summary Tables Class:
More informationAsthma 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 informationGlobal Strategy for the Diagnosis, Management and Prevention of COPD 2016 Clinical Practice Guideline. MedStar Health
Global Strategy f the Diagnosis, Management and Prevention of COPD 2016 Clinical Practice Guideline MedStar Health These guidelines are provided to assist physicians and other clinicians in making decisions
More 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. 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 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 informationDrug 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 informationASTHMA 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 informationAsthma. 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 informationDiagnosis, 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 informationAsthma 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 informationChronic Obstructive Pulmonary Disease
COPD Guideline Team Team Leader Davoren A Chick, MD General Medicine Team Members Paul J Grant, MD General Medicine Meilan K Han, MD, MS Pulmonary Medicine R Van Harrison, PhD Medical Education Elisa B
More informationBetter 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 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 informationAllergies 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 informationKey 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 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 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 informationAnyone who smokes and/or has shortness of breath and sputum production could have COPD
COPD DIAGNOSIS AND MANAGEMENT CHECKLIST Anyone who smokes and/or has shortness of breath and sputum production could have COPD Confirm Diagnosis Presence and history of symptoms: Shortness of breath Cough
More informationUPMC 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 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 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 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 informationSession 1: Clinical Transi ons and Preven on of Hospital Readmissions C: Chronic Obstruc ve Pulmonary Disease 11:15am - 12:15pm
January 20-22, 2012 Des Moines Marrio, 700 Grand Avenue, Des Moines, IA Session 1: Clinical Transi ons and Preven on of Hospital Readmissions C: Chronic Obstruc ve Pulmonary Disease 11:15am - 12:15pm ACPE
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 informationNancy 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 informationChronic Obstructive Pulmonary Disease
Scope of Problem Chronic Obstructive Pulmonary Disease Marianne J. Davies, RN, MSN, APRN Yale University School of Medicine Yale Comprehensive Cancer Center Nevada Cancer Institute 2005 Hospitalizations
More information(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 informationProposed Preferred Drug List. Clinical Criteria
Proposed Preferred Drug List with Clinical Criteria Proposal for TennCare February 7, 2008 Page 1 of 87 PDL Decision Process The primary clinical decision that needs to be made is determining if the drugs
More informationIncorporating 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 informationFerris 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 informationof COPD Wayne Kradjan, Pharm. D. Dean and Professor Oregon State University College of Pharmacy
Pathophysiology and Treatment of COPD Wayne Kradjan, Pharm. D. y j, Dean and Professor Oregon State University College of Pharmacy COPD Consensus Statementst t Global Initiative for Chronic Obstructive
More informationCommon Inhaled Asthma Medications Dose Comparison and Tips for Use
Detail-Document #210303 This Detail-Document accompanies the related article published in PHARMACIST S LETTER / PRESCRIBER S LETTER March 2005 ~ Volume 21 ~ Number 210303 Common Inhaled Asthma Medications
More informationHistory & Development
RSPT 2317 Anticholinergic Bronchodilators () History & Development Prototypical parasympatholytic agent is atropine an alkaloid found naturally in the plants Atropa belladona (nightshade) and Datura species
More informationYou ve come a long way, baby.
COPD Dr Badri Paudel Dept of Medicine GMC/CHRC 4/22/12 badri@gmc 2 You ve come a long way, baby. Wayne McLaren Former Marlboro Man 4/22/12 badri@gmc 3 Age 30 a robust young man Age 51 riding into the sunset
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 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 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 informationTake My Breath Away: COPD Update. Jason Henderson D.O. Warren Clinic Pulmonary & Critical Care
Take My Breath Away: Update Jason Henderson D.O. Warren Clinic Pulmonary & Critical Care Objectives 1. Recognize clinical signs and symptoms associated with chronic bronchitis and emphysema. 2. Describe
More informationEnd 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 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 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 informationChapter Eight Help Your Medicines Help You
Management of Chronic Obstructive Lung Disease 慢性阻塞性肺病的治療與護理 Chapter Eight Help Your Medicines Help You Perhaps you ve been told that there are no wonder drugs to cure your lung disease. There are, however,
More informationFirst to Market or 505 (b)2 CMC Considerations IPAC-RS/UF Orlando Inhalation Conference Orlando, Florida
First to Market or 505 (b)2 CMC Considerations IPAC-RS/UF Orlando Inhalation Conference Orlando, Florida Prasad Peri, Ph.D., Branch Chief, ONDQA, FDA March 19, 2014 1 Topics for discussion Introduction
More informationSelect Inhaled Respiratory Agents
Applies to all products administered or underwritten by Blue Cross and Blue Shield of Louisiana and its subsidiary, HMO Louisiana, Inc.(collectively referred to as the Company ), unless otherwise provided
More informationCOPD is a syndrome of chronic limitation in expiratory airflow encompassing emphysema or chronic bronchitis.
1 Definition of COPD: COPD is a syndrome of chronic limitation in expiratory airflow encompassing emphysema or chronic bronchitis. Airflow obstruction may be accompanied by airway hyper-responsiveness
More informationCOPD- pulmonary hyperinflation- the diaphragms are at the level of the eleventh posterior ribs and appear flat.
COPD COPD Hallmark symptom - Dyspnea Chronic productive cough Minor hemoptysis pink puffer blue bloater COPD- pulmonary hyperinflation- the diaphragms are at the level of the eleventh posterior ribs and
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 informationStaying 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 informationLearning 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 informationInhaled 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 informationTECH TALK CE THE NATIONAL CONTINUING EDUCATION PROGRAM FOR PHARMACY TECHNICIANS
Instructions 1 CEU FREE CE FOR TECHNICIANS Tech Talk CE is Canada s first and only continuing education correspondence program specifically designed for technicians. It s brought to you by the publishers
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 informationInhaled 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 informationBronchiectasis. 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 informationLearning 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 informationWhat is New in COPD: Times Are Changing! Meredith Chiasson, MD, FRCPC April 6, 2018
What is New in COPD: Times Are Changing! Meredith Chiasson, MD, FRCPC April 6, 2018 No disclosures Disclosures objectives How to diagnose & Assess severity Treatment: Pharmacologic Non-Pharmacologic Maintenance
More informationLecture Notes. Chapter 4: Chronic Obstructive Pulmonary Disease (COPD)
Lecture Notes Chapter 4: Chronic Obstructive Pulmonary Disease (COPD) Objectives Define COPD Estimate incidence of COPD in the US Define factors associated with onset of COPD Describe the clinical features
More informationIntegrated Cardiopulmonary Pharmacology Third Edition
Integrated Cardiopulmonary Pharmacology Third Edition Chapter 13 Pharmacologic Management of Asthma, Chronic Bronchitis, and Emphysema Multimedia Directory Slide 7 Slide 12 Slide 60 COPD Video Passive
More informationChronic obstructive pulmonary disease (COPD) is characterized
DANIEL E. HILLEMAN, PharmD ABSTRACT OBJECTIVE: To review the role of long-acting bronchodilators in the treatment of chronic obstructive pulmonary disease (COPD), including the importance of treatment
More informationClinical 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 informationAIRDUO RESPICLICK (fluticasone-salmeterol) aerosol DULERA (mometasone furoate and formoterol fumarate dihydrate) aerosol
DULERA (mometasone furoate and formoterol fumarate dihydrate) aerosol Coverage for services, procedures, medical devices and drugs are dependent upon benefit eligibility as outlined in the member's specific
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 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 informationRespiratory 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 informationCHRONIC OBSTRUCTIVE PULMONARY DISEASE
CHRONIC OBSTRUCTIVE PULMONARY DISEASE Chronic Obstructive Pulmonary Disease (COPD) is a slowly progressive disease of the airways that is characterized by a gradual loss of lung function. In the U.S.,
More informationEffective 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 informationChronic Obstructive Pulmonary Disease
Quality Department Guidelines for Clinical Care Ambulatory COPD Guideline Team Team Leader Davoren A Chick, MD General Medicine Team Members Paul J Grant, MD General Medicine R Van Harrison, PhD Learning
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 Guidelines and updates
Chronic Obstructive Pulmonary Disease Guidelines and updates October 20, 2018 Saratoga Springs, NY COPD (Chronic obstructive pulmonary disease) is a major cause of mortality and morbidity in the United
More informationCOPD/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