1 / 38

COPD + ASTHMA

COPD + ASTHMA. Matt Wong + Sheila Murphy Dec 13 th 2011. CONTENTS. AKT MINI EXAM NICE – COPD GUIDELINES BTS ASTHMA GUIDELINES INHALER TECHNIQUE QOF SPIROMETRY CSA EXERCISE. AKT. Which of the following are used in assessing the severity of COPD? A. Body mass index (BMI) B. Age

zora
Download Presentation

COPD + ASTHMA

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. COPD + ASTHMA Matt Wong + Sheila Murphy Dec 13th 2011

  2. CONTENTS • AKT MINI EXAM • NICE – COPD GUIDELINES • BTS ASTHMA GUIDELINES • INHALER TECHNIQUE • QOF • SPIROMETRY • CSA EXERCISE

  3. AKT • Which of the following are used in assessing the severity of COPD? • A. Body mass index (BMI) • B. Age • C. Medical Research Council (MRC) dyspnoea score • D. Smoking pack year history • E. Lung function

  4. AKT • Which of the following statements apply to COPD? • A. It is more common in those from upper social classes • B. It is often seen as a co-morbidity in patients with ischaemic heart disease and lung cancer • C. Mortality from COPD is evenly spread across the UK as a whole • D. The estimated prevalence of COPD in patients over 40 years of age is 9-10%

  5. AKT • What percentage of patients will die within 3 months of admission for a COPD-related condition? • A. 33% • B. 50% • C. 5% • D. 20%

  6. AKT • Pulmonary rehabilitation should be offered to: • A. All patients with moderate or severe COPD • B. All patients with COPD irrespective of their MRC score • C. Patients who are poorly motivated • D. All patients who meet the referral criteria regardless of their inhaled drug therapy • E. Patients with an MRC dyspnoea score of 3 or more unless they are on long-term oxygen therapy (LTOT)

  7. AKT • Which of the following statements about the role of inhaled corticosteroids in COPD are true? • A. In patients with moderate/ severe COPD (FEV1 <50% predicted), treatment of the lung inflammation with inhaled corticosteroids has not shown to be of benefit in reducing exacerbations • B. There is no evidence to suggest that early use of inhaled steroids in patients with COPD will reduce the decline in FEV1 seen over years • C. The use of inhaled corticosteroids has been shown to be of some benefit in reducing the decline in health status seen in patients with moderate/ severe COPD (FEV1 <50% predicted) • D. Osteoporosis is commonly seen in patients taking high dose inhaled corticosteroids

  8. AKT • Which of the following features suggest a patient should be admitted to hospital for management of their COPD exacerbation? • A. Cyanosis • B. Mild peripheral oedema • C. Low oxygen saturation (<90%) • D. Good level of activity • E. Significant co-morbidities

  9. AKT • Which of the following statements about oxygen therapy in COPD exacerbations are true? • A. It should be given to all patients • B. It should be started at 100% until the oxygen saturation is >95% • C. It should be monitored by pulse oximetry until access to full arterial or capillary blood gases are available • D. In patients on LTOT it should be given at the same rate as they receive at home

  10. AKT

  11. AKT

  12. ANSWERS to AKT • 1. A, C, E • 2. B, D • 3. E • 4. B • 5. C, D • 6. A, C, E • 7. C, D • 8. 3 • 9. D

  13. AKT

  14. AKT

  15. NICE + COPD • Consider COPD in smokers >35 and with exertional SOB, chronic cough, regular sputum production, winter bronchitis, wheeze • No features of asthma – unproductive cough, diurnal variation, night-time waking with wheeze/breathlessness • Ask about: weight loss, fatigue, exercise tolerance, chest pain, night waking, haemoptysis, ankle swelling, occupational hazards

  16. InVESTIGATIONS • Post-bronchodilator spirometry • CXR • FBC – anaemia/polycythaemia • BMI • FEV1/FVC < 0.7 = COPD • Stage 1-5  mild to very severe based on FEV1 % • >80% is mild • 30% - 50% severe • People must be symptomatic to make diagnosis!

  17. MRC Dyspnoea Scale • Grade 1 – not troubled by SOB except on exercise • Grade 2 – SOB when hurrying/walking up hill • Grade 3 – walks slower on level ground due to SOB, or has to stop when walking at own pace • Grade 4 – stops for breath after 100m or a few mins on ground level • Grade 5 – too breathless to leave the house or breathless when dressing

  18. MANAGEMENT • Smoking cessation for all • Start treatment once diagnosis confirmed • Pulmonary rehab • For those with disability/recent admission

  19. Drug ThERAPY • SABA : short acting B agonist • salbutamol • LABA : long acting B agonist • salmeterol • SAMA : short acting muscarinic antagonist • ipratropium • LAMA : long acting muscarinic antagonist • Tiotropium • ICS : inhaled corticosteroids • Beclometasone, fluticasone, budesonide

  20. NICE Management

  21. Oral THERAPIES • Theophylline • If inhaled therapy ineffective/can’t be used • Oral steroids • Maintenance steroids not recommended, but if severe COPD may be necessary, aim for low dose and monitor for osteoporosis • 30mg for 7-14 days in exacerbations • LTOT used for 15 hours/day • Assess need for LTOT if FEV1<30%, cyanosis, polycythaemia, peripheral oedema, raised JVP, sats < 92% on air • 2 x ABGs 2 occasions, 3 weeks apart • LTOT if PaO2 < 7.3kPa or 7.3 – 8 with complications

  22. MANAGEMENT OF EXACERBATIONS • Increase frequency of broncholdilator use/consider use of nebuliser • Prescribe oral abx if sputum purulent/clinical signs of peumonia • Steroid 30mg 7-14 days • Self-Management • Start abx/steroid if SOB increases/interferes with ADLs • Abx if sputum purulent • Adjust bronchodilator to control symptoms

  23. CONSIDER ADMISSION • not able to cope at home • severe beathlessness, Sats <90% • general condition is poor/ deteriorating • cyanosis is present • worsening peripheral oedema • impaired level of consciousness • patients on LTOT • acute confusion • exacerbation has had a rapid rate of onset • significant comorbidity - cardiac disease and IDDM • changes on CXR • arterial pH level < 7.35 • arterial PaO2 < 7 kPa

  24. BTS ASTHMA GUIDELINES – DIAGNOSIS in CHILDREN

  25. BTS ASTHMA GUIDELINES – DIAGNOSIS in CHILDREN

  26. BTS ASTHMA GUIDELINES – DIAGNOSIS in ADULTS

  27. BTS ASTHMA GUIDELINES – DIAGNOSIS in ADULTS

  28. BTS ASTHMA GUIDELINES – TREATMENT in ADULTS

  29. BTS ASTHMA GUIDELINES – DIAGNOSIS in CHILDREN AGED 5-12

  30. BTS ASTHMA GUIDELINES – DIAGNOSIS in CHILDREN AGED <5

  31. COSTS • Salbutamol CFC Free 100mcg/dose • 3£ / 200 doses • Ipratropium 20 mcg • 5£ / 200 doses • Salmeterol 50 mcg • 29£ / 60doses/ 1 month • Salmeterol 50 mcg and fluticasone • 35£ / 60 doses/ 1 month • Tiotropium • 32£ / 30 doses/ 1 month

  32. meTered dose inhaler • Contains a pressurised inactive gas that propels a dose of drug in each 'puff' • ADV • most widely used inhaler • quick to use, small, and convenient to carry • DISADV • needs good co-ordination to press the canister, and breathe in fully at the same time

  33. SPACER DEVICES • Used with pressurised MDIs • The spacer between the inhaler and the mouth holds the drug like a reservoirwhen the inhaler is pressed • Valve at the mouth end ensures that the drug is kept within the spacer until you breathe in. When you breathe out, the valve closes. • Adv – No need to have good co-ordination to use a spacer device. • A facemask can be fitted on to some types of spacers, instead of a mouthpiece. This is sometimes done for young children and babies who can then use the inhaler simply by breathing in and out normally through the mask.

  34. Breath-activated inhalers • Alternatives to the standard MDI • Don't require you to press a canister on top • Bottom 3 are dry powder inhalers. • Dose is triggered by breathing in at the mouthpiece. You need to breathe in fairly hard to get the powder into your lungs. • Accuhalers • Clickhalers • Easyhalers • Novolizers • Turbohalers • diskhalers • Twisthalers • ADV - Require less co-ordination than the standard MDI. • DISADV - They tend to be slightly bigger than the standard MDI. Autohaler

  35. QOF • Practice register of patients with COPD • % with COPD in whom diagnosis has been confirmed by spirometry with reversibility testing • % with COPD with record of smoking status in the previous 15m • % with COPD who smoke, who have been offered smoking cessation advice or referral to a specialist service, where available in last 15 months • % with COPD with a record of FEV1 in the previous 27m • % with COPD with record that inhaler technique has been checked in the preceding 27m • % with COPD who have had influenza immunisation in the preceding 1 September to 31 March • PROMPTS: • MRC Dysponea Score, FEV1, REVIEW EVERY 15m • OUR PRACTICE: • Inhaler technique, sats, smoking, exacerbations, immunisations, depression

  36. QOF - ASTHMA

  37. SPIROMETERY EXERCISE

  38. CSA EXERCISE

More Related