Lecture 10: Pharmaceutical Care of People living with COPD Flashcards
What are the clinical indicators for considering a diagnosis of COPD?
- Dyspnea that is progressive over time, worse with execrise, persistent
- Recurrent wheeze
- Chronic cough: may be intermittent and may be unproductive
- Recurrent lower respiratory tract infections
- History of risk factors
What are the COPD risk factors?
- Tobacco smoke
- Smoke from home cooking and heating fuels
- Occupational dusts, vapors, fumes, gases and other chemicals
- Host factors (genetic factors, developmental abnosrmalites…)
Compare the differences between CODP and asthma
- Nearly all COPD have a smoking history, asthma patients not always
- Symptoms under age of 35 are extremely rare for COPD patients and common for asthma
- Chronic productive cough is common in COPD patients and uncommon in asthma patients
- Breathlessness is progressive/ persistent in COPD but variable in asthma
- Night time wakening breathlessness +/- wheeze is uncommon in COPD but common in asthmatics
- Diurenal or day to day variability is uncommon in COPD but common in asthma
What are the pulmonary function tests?
- Spirometry
- FEV1
- FVC
- FEV1/FVC
What is the FEV1?
The FEV1 indicates the amount of air exhaled with maximum effort in the first second. Important in pre- and post-bronchodilator tests in determining the effects of bronchodilators on the airways
What is FVC?
The FVC is the total volume of air exhaled with maximal effort
What is used as a marker of progression of COPD?
FEV1/FVC
What is grade 1 on the MRC dyspnoea scale?
Not troubled except on strenuous exercise
What is grade 2 on the MRC dyspnoea scale?
Short of breath when hurrying on the flat or walking up a slight hill
What is grade 3 on the MRC dyspnoea scale?
Walks slower than most on the flat, stops after about a mile, or stops after walking 15mins at own pace
What is grade 4 on the MRC dyspnoea scale?
Stops for breath after walking 100 yards or a few minutes on the level
What is grade 5 on the MRC dyspnoea scale?
Too breathless to leave the house, or when undressing
What are the aims of management of stableCOPD
- Reduce symptoms
- Improve exercise tolerance
- Improve health related quality of life
- Prevent exacerbations
- Provide a package of care that meets the patients needs
- Provide treatment that minimises the risk of adverse effects
- Reduce mortality
- Prevent disease progression
What are the adjuncts to pharmacological management of COPD?
- Smoking cessation
- Pulmonary rehabilitation
- Vaccination
- Pneumococcal and influenza and COVID
- Physiotherapy
- Nutrition
- Treatment of anxiety and depression
What are the fundamentals of COPD care?
- Offer treatment and support to stop smoking
- Offer pneumococcal and influenza vaccinations
- Offer pulmonary rehabilitation if indicated
- Co-develop a personalisaed self management plan
- optimise treatment for comorbidities
What is offered to a patient if they are limited by symptoms or have exacerbations despite treatment and have no asthmatic featured or features suggesting steroid responsiveness?
LABA + LAMA
What is offered to a patient with asthmatic features or features suggesting steroid responsiveness?
LABA + ICS
What is offered to a person that has day to day symptoms that adversly impact quality of life?
- Consider 3 month trial of LABA + LAMA + ICS
- If no improvement, revert to LABA + LAMA
What is offered to patients that have 1 severe or 2 moderate exacerbations in a year?
LABA + LAMA + ICS
What are the adverse effects of corticosteroids?
- Neuropsychological
- Musculoskeletal
- Endocrine and metabolic
- Skin
- Gastrointestinal
- Ophthalmic
- Immunosuppression
When are corticosteroids use strongly favoured?
- History of hospitilization for exacerbations of COPD
- > 2 moderate exacerbation of COPD per year
- Blood eosinophils > 300 cells/nl
- History of, or conomitant asthma
When are corticosteroids against use?
- Repeated pnuemonie events
- Blood eosinophils <100 cells/nl
- Mycobacterial infection
Which patients use SABA?
Used only in mild COPD but all patients will normally have a SABA inhaler
When are LABA used?
Only used in combination with ICS (NICE ) or LAMA (NICE and GOLD)
What LABA has a rapid onset?
Formoterol
What are other treatments for COPD?
- Theophylline
- Mucolytics
- Nebulised bronchodilators
