CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Transcription

1 A F O C A l p O I N T l E A r N I N g p r O g r A m m E CHRONIC OBSTRUCTIVE PULMONARY DISEASE S E C O N D E D I T I O N BOOK 1 September 2013 FP120/1 CENTRE FOR PHARMACY POSTGRADUATE EDUCATION

2 About CPPE focal point programmes We have developed focal point to give you short, clinically focused learning sessions. It will help you learn with your colleagues and improve the services you offer your patients. Each unit presents information and activities that are relevant for pharmacy professionals working in primary care and in the community. There are two types of learning event for you to choose between when using focal point units you can either attend a CPPE tutor-led event or can learn as part of a CPPE learning community. Have a look at the CPPE website: for more information about how to set up a learning community. focal point COPD Book 1 Reference sources for all the books, articles, reports and websites mentioned in the text can be found at the end of the programme. References are indicated in the text by a superscript number (like this 3 ). This book gets you started. It provides key information to help you meet the learning objectives presented overleaf, but it also encourages you to identify your own learning needs. It then challenges you to relate what you have learnt to your own area of practice and professional development. We have included practice points and talking points to stimulate your thinking and we will refer to these again at the focal point event. Make sure you have studied these activities before your event. You will receive Book 2 when you attend the focal point event. It uses a case study and clinical vignettes to help you apply what you have learnt and encourages you to make changes to improve your practice. We also include some suggested answers to the learning activities. About this focal point unit on COPD In this unit we consider: the recent trends in COPD the causes, risk factors and pathogenesis of COPD how COPD is diagnosed the management of COPD, including drug and non-drug therapies the specific roles of various medicines in stable disease and acute exacerbations. 5

3 focal point COPD Book 1 Learning objectives You can meet the learning objectives that we identify here by reading the information that we provide and refer you to, undertaking the various activities that we suggest and putting what you have learnt into practice. We have split our learning objectives into appropriate sections. This should help you determine how to meet them. We have also linked the learning objectives in this programme to the General Level Framework (GLF) and the NHS Knowledge and Skills Framework (KSF) dimensions. We have suggested some competences, but you may be able to apply your learning to other aspects of these frameworks. Moving into focus and Reading Objective KSF GLF Recognise the signs, Quality Cluster: Delivery of symptoms and complications Level 3 patient care of COPD. Competency: Medicines information and patient education Describe how to differentiate Quality Cluster: Problem solving COPD from other diseases Level 3 Competency: Knowledge of the respiratory tract. Describe the diagnostic process Quality Cluster: Delivery of and how patients with COPD Level 3 patient care are classified according to Competency: Patient severity of disease. assessment Evaluate the clinical Quality Cluster: Delivery of management of patients with Level 3 patient care COPD in the context of the Competency: Medicines National Institute for Health information and patient and Care Excellence (NICE) education guidance and quality standards. 6

4 Practice points, talking points, case studies and clinical vignettes You ll find these in this book and Book 2, and will work on them during the event. Objective KSF GLF Assess symptoms that could Quality Cluster: Delivery of patient care be suggestive of Level 3 Competency: Patient undiagnosed COPD. assessment focal point COPD Book 1 Describe how COPD Quality Cluster: Delivery of patient care management varies Level 3 Competency: Monitoring drug according to severity therapy of disease. Provide information to Communication Cluster: Delivery of patient care patients to support Level 2 Competency: Medicines management of their information and patient education condition. Cluster: Personal Competency: Effective communication skills, professionalism Directing change scenarios and follow-up activities You will achieve practical outcomes after completing this unit, when you apply what you have learnt to your everyday practice. You will find advice in Book 2. Objective KSF GLF Identify 5 key interventions Quality Cluster: Management and that can improve outcomes Level 3 organisation for patients with COPD and Competency: Service describe how pharmacy Service development teams can contribute. Improvement Level 2 7

5 focal point COPD Book 1 Moving into focus Consider the following questions. Use them to focus your thoughts and stimulate your learning. Are you confident you know the answers? 1. List the respiratory and non-respiratory symptoms of COPD. 2. In patients with COPD who continue to smoke, why is it important to encourage them to stop? 3. What is the role, if any, of corticosteroids in the treatment of COPD? 4. List currently available drugs in the following groups, that have a license for use in COPD: Short-acting beta 2 agonists (SABAs), Short-acting muscarinic antagonists (SAMAs), Long-acting muscarinic antagonists (LAMAs), Long-acting beta 2 agonists (LABAs) and LABA with inhaled corticosteroid (ICS) combinations. 5. What is the definition of an exacerbation of COPD? 10

6 focal point COPD Book 1 3. Managing stable COPD COPD is a progressive, irreversible lung disease. Once it develops, it can be managed, although not cured. Early diagnosis and treatment can slow or stop the progression of the illness. Patients should be identified as early in the course of the disease as possible, and certainly before the end stage of the illness when disability is substantial. As a result, earlier and more accurate diagnosis and initiatives to prevent exacerbations and delay disease progression are all priorities for the management of COPD. 8 Although there is no cure for COPD, management can control symptoms, maintain lung function, improve health-related quality of life, and reduce the frequency and severity of exacerbations. 3.1 Smoking cessation The most effective means of modifying COPD is stopping smoking. In many drug trials, it has been found that over 40 percent of patients with COPD are current smokers as oppose to current population prevalence of smoking in the UK of approximately 25 percent. Therefore encouraging patients with COPD to stop smoking is one of the most important components of their management. All COPD patients still smoking, regardless of age, should be encouraged to stop, and offered help to do so at every opportunity. 2 Estimates suggest that smoking cessation leads to a sustained 50 percent reduction in the rate of lung function decline. 23,24 However, while lung function decline may be slowed to nearer the age-related norm, the damage done cannot be reversed. Figure 2: Relationship between smoking, enhanced decline in lung function and age in patients with COPD 22 From Fletcher C, British Medical Journal 1977;1: 1645