PULMONARY DISEASE INCIDENCE UP TO 380,000 PEOPLE IN IRELAND HSE - PowerPoint PPT Presentation

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.

Beta 2 agonists • 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

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

Umeclidinium • Long acting anti muscarinic • Once daily dosing • Longer duration of action • Causes relaxation of airway muscle, improved lung function and decreased mucus secretion

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 combination • Indicated when COPD is uncontrolled with bronchodilation monotherapy. • Budesonide and Formoterol (Symbicort) • Twice daily or PRN? • Fluticasone and Vilanterol (Relvar Ellipta) • Once daily dosing

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 • Relaxation and Mindfulness • Physio • Video on COPD support • Helps control website breathlessness • Helps prevent anxiety associated with COPD around shortness of • Helps prevent panic breath when you feel short of • Takes practice and breath patience!!

References • Copdfoundation.org • Copd society • Medline plus • Nhlibi.nih.gov • Healthline.com • Nhs.uk/copd