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
WHAT IS COPD? PROGRESSIVE DISEASE THAT MAKES IT DIFFICULT TO BREATHE ITS AN UMBRELLA TERM USED TO DESCRIBE PROGRESSIVE LUNG DISEASES INCLUDING EMPHYSEMA, CHRONIC BRONCHITIS CHARACTERISED BY INCREASING BREATHLESSNESS
SYMPTOMS CHRONIC COUGH WHEEZING SHORTNESS OF BREATH FATIGUE RECURRENT RESPIRATORY INFECTIONS WEIGHT LOSS MORNING HEADACHES SWOLLEN FEET AND ANKLES
GRADES O- ONLY SOB DURING OR AFTER STRENUOUS EXERCISE 1- SOB WHEN HURRYING. COUGH OR MUCUS NOT USUSALLY PRESENT. PFT 80% OF PREDICTED RESPONSE 2-SOB ON LEVEL SURFACES.STOP FOR RESTS TO CATCH BREATH. COUGH OR MUCUS MAY BE PRESENT. MANY FIRST SEEK MEDICAL CARE AT THIS STAGE. PFT 50-80%
GRADES 3- STOP TO REGAIN BREATH AFTER ONLY A FEW MINUTES OF WALKING ON A LEVEL SURFACE. COUGH AND MUCUS PRESENT. EXERCISE VERY DIFFICULT AT THIS POINT. INCREASED FATIGUE AND QUALITY OF LIFE BEGINS TO SUFFER. PFT 30-50% 4- TOO BREATHLESS TO LEAVE HOUSE. SOB DURING EVERYDAY ACTIVITIES.TROUBLE BREATHING MAY BE LIFE THREATHENING DURING SOME EPISODES. PFT LESS THAN 30%
CAUSES CIGARETTE SMOKING 80-90% LONG TERM EXPOSURE TO LUNG IRRITANTS AIR POLLUTION CHEMICAL FUMES DUST HEREDITARY
Treatments Lifestyle changes- 1. Quit smoking 2. Avoid second hand smoke and fumes 3. Healthy diet and water consumption 4. Exercise- check with doctor 5. Breathing exercises- physio 6. Relaxation and Mindfulness
Medicines Beta 2 agonists 1. Short acting- salbutamol (Ventolin) 2. Long acting- salmeterol, formoterol,vilanterol and indacaterol Mechanism of action- Relaxes the smooth muscle of the bronchioles and relieves bronchospasm. They also facilitate expectoration.
Indacaterol (Onbrez) Long acting Beta 2 agonist, once daily dosing Maintenance bronchodilation Administer at the same time of day Acts locally in the lungs to relax bronchial muscle and aid bronchodilation. Technique Beta 2 agonists
Anticholinergics Anticholinergics prevent bronchoconstriction( airways tightening) and helps clear mucus. Short acting- Ipratropium (Atrovent) Long acting- Tiotropium (Spiriva) - Umeclidinium (Incruse Ellipta) - Glycopyrrolate (Seebri)
Tiotropium Long Acting anti muscarinic Handihaler is once daily dosing Significant clinical benefit Respimat dose
Long acting anti muscarinic Once daily dosing Longer duration of action Causes relaxation of airway muscle, improved lung function and decreased mucus secretion Umeclidinium
Glycopyrrolate Long acting anti muscarinic Once daily dosing Long term maintenance treatment
Combination of LABA and LAMA
Combination therapy LAMA and LABA Umeclidium and vilanterol (Anoro Ellipta) Once daily dosing Glycopyrrolate and Vilanterol (Ultibro) Once daily dosing
Corticosteroids Inhibits bronchoconstriction, induces muscle relaxation. Decreases inflammatory cells in turn decreasing airway hyper responsiveness Use of oral steroids in the treatment of acute exacerbations is widely accepted and recommended. Nebules and inhalers
Steroid and Beta 2 agonist Indicated when COPD is uncontrolled with bronchodilation monotherapy. Budesonide and Formoterol (Symbicort) Twice daily or PRN? Fluticasone and Vilanterol (Relvar Ellipta) Once daily dosing combination
Other therapies Nebules- Available in short acting beta 2 agonists and short acting anticholinergics, Steroids and Saline. Side effects?? Xanthine derivatives- Theophylline Limited to use as an adjunctive Narrow therapeutic Index Side effects and Interactions
Antibiotics Azithromycin Used to treat acute bacterial exacerbations of COPD caused by a variety of bacteria. Offers decreased GI upset Increased compliance through reduced dosing frequency. Anti inflammatory properties Dose?
Mucolytics Carbosysteine Available as cough bottle Exputex Dose Erdosteine Capsules 300mg twice daily for max 10 days
Alternative therapies Breathing Exercise Physio Helps control breathlessness associated with COPD Helps prevent panic when you feel short of breath Relaxation and Mindfulness Video on COPD support website Helps prevent anxiety around shortness of breath Takes practice and patience!!
References Copdfoundation.org Copd society Medline plus Nhlibi.nih.gov Healthline.com Nhs.uk/copd