5. COPD Flashcards
O. Have an understanding of smoking as a public health problem
See dates of interventions and facts!!!!!!!
Impact of smoking: economic
● smoking cost the NHS in the UK £5.2 billion in 2005/06, approximately 5.5% of total healthcare costs (Allender, 2009)
● In 2013, a 20 a day smoker of a premium cigarette brand will spend about £2,900 a year on cigarettes
● Policy Exchange in 2010 (Nash & Featherstone) estimated the total cost to society of smoking to be £13.74 billion.
● Loss in productivity from smoking breaks (£2.9bn)
● Increased absenteeism (£2.5bn)
● Other costs include:
o cleaning up cigarette butts (£342 million), the cost of fires (£507m)
o loss of economic output from the death of smokers (£4.1bn) and passive smokers (£713m)
Impact of smoking
● Single greatest cause of illness and premature death in the UK
● About 100,000 people die in UK each year due to smoking
● Cancers, COPD and heart disease
O. describe in basic detail smoking cessation programmes
free local Stop Smoking Service -online, phone too
NRT, e-cigarettes,Varenicline (Champix) red, cravings, Bupropion (Zyban)
O. Have an understanding of the structure of integrated primary care teams and the care of housebound patients
stopping smoking – if you have COPD and you smoke, this is the most important thing you can do
inhalers and medications – to help make breathing easier:
pulmonary rehabilitation – a specialised programme of exercise and education
surgery or a lung transplant – although this is only an option for a very small number of people
long term: Nebulised medication
Long-term oxygen therapy
Ambulatory oxygen therapy
Non-invasive ventilation (NIV)
Current WHO Health def
WHO 1984 :“The extent to which an individual or a group is able to realise aspirations and satisfy needs, and to change or cope with the environment.Health is a resource for everyday life, not the objective of living; it is a positive concept emphasising social and personal resources as well as physical capabilities”
*****O. Understand basic lung function tests and their uses
● Spirometry
o Measures FEV1 (amount of air you can breathe out in one second) and FVC (Total amount of air you breathe out
o Readings compared to normal for age and BMI
o if FEV1 ≥ 50% predicted: either long-acting beta2 agonist (LABA) or long-acting muscarinic antagonist (LAMA)
o If FEV1 < 50% predicted: either LABA with an inhaled corticosteroid (ICS) in a combination inhaler, or LAMA. [new 2010]
See ppt!!!!!!!!
● Peak Flow test
o Checks not asthma
COPD symptoms
● Increasing breathlessness when active
● Persistent cough with phlegm
● Frequent chest infections
O. Have an awareness of COPD, its aetiology,
● Characterized by airflow restriction that is not fully reversible
● The following should be used as a definition of COPD:
o Airflow obstruction is defined as a reduced FEV1/FVC ratio (where FEV1 is forced expired volume in 1 second and FVC is forced vital capacity), such that FEV1/FVC is less than 0.7.
o If FEV1 is ≥ 80% predicted normal a diagnosis of COPD should only be made in the presence of respiratory symptoms, for example breathlessness or cough
● Name for a collection of lung diseases including chronic bronchitis, emphysema and chronic obstructive airways disease.
● 3 million in UK only around 9000 diagnosed
● Main cause is smoking. Likelihood increases the more you smoke and the longer you’ve been smoking. This is because smoking irritates and inflames the lungs resulting in scarring
● Inflammation leads to permanent changes in the lung.
o The walls of the airways thicken and more mucus is produced.
o Damage to the delicate walls of the air sacs in the lungs causes emphysema and the lungs lose their normal elasticity.
o The smaller airways also become scarred and narrowed.
o These changes cause the symptoms of breathlessness, cough and phlegm associated with COPD.
O. To have an awareness of ethical issues around treating conditions with an element of self infliction.
Precontemplation Contemplation Preparation Action Maintainance Relapse
Autonomy…
COPD management
● Damage to lungs cannot be reversed but progression of the disease can be slowed.
● Stop smoking
● Relieve symptoms by medication e.g. inhaler to make breathing easier
● In people with stable COPD who remain breathless or have exacerbations despite use of shortacting bronchodilators as required, offer the following as maintenance therapy:
o if FEV1 ≥ 50% predicted: either long-acting beta2 agonist (LABA) or long-acting muscarinic antagonist (LAMA)
o If FEV1 < 50% predicted: either LABA with an inhaled corticosteroid (ICS) in a combination inhaler, or LAMA. [new 2010]
● Pulmonary rehab may also help increase the amount of exercise you are capable of
● Manage exacerbations:
o giving self-management advice on responding promptly to the symptoms of an exacerbation
o starting appropriate treatment with oral steroids and/or antibiotics
o use of non-invasive ventilation when indicated
o use of hospital-at-home or assisted-discharge schemes
House care model????
House of Care model
● 5 million people in England with long term conditions have the greatest healthcare needs of the population (50% of all GP appointments and 70% of all bed days) and their treatment and care absorbs 70% of acute and primary care budgets in England
● NHS England and partners are using the ‘House of Care’ model as a checklist/metaphor for these building blocks of high quality person-centred coordinated care.
● The House relies on four key interdependent components, all of which must be present for the goal, person-centred coordinated care, to be realised:
1. Commissioning – which is not simply procurement but a system improvement process, the outcomes of each cycle informing the next one.
2. Engaged, informed individuals and carers – enabling individuals to self-manage and know how to access the services they need when and where they need them.
3. Organisational and clinical processes – structured around the needs of patients and carers using the best evidence available, co-designed with service users where possible.
4. Health and care professionals working in partnership – listening, supporting, and collaborating for continuity of care.
