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

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

Jan 06, 2024 228 likes •525 views

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?

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SLIDE 1

CHRONIC OBSTRUCTIVE PULMONARY DISEASE

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SLIDE 2

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
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SLIDE 3

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

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SLIDE 4

SYMPTOMS

  • CHRONIC COUGH
  • WHEEZING
  • SHORTNESS OF BREATH
  • FATIGUE
  • RECURRENT RESPIRATORY INFECTIONS
  • WEIGHT LOSS
  • MORNING HEADACHES
  • SWOLLEN FEET AND ANKLES
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SLIDE 5

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%

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SLIDE 6

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%

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SLIDE 7

CAUSES

  • CIGARETTE SMOKING 80-90%
  • LONG TERM EXPOSURE TO LUNG IRRITANTS
  • AIR POLLUTION
  • CHEMICAL FUMES
  • DUST
  • HEREDITARY
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SLIDE 8

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
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SLIDE 9
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SLIDE 10
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SLIDE 11
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SLIDE 12

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.

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SLIDE 13

Beta 2 agonists

  • Indacaterol (Onbrez)

Long acting Beta 2 agonist,

  • nce daily dosing

Maintenance bronchodilation Administer at the same time

  • f day

Acts locally in the lungs to relax bronchial muscle and aid bronchodilation. Technique

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SLIDE 14

Anticholinergics

  • Anticholinergics prevent bronchoconstriction(

airways tightening) and helps clear mucus.

  • Short acting- Ipratropium (Atrovent)
  • Long acting- Tiotropium (Spiriva)
  • Umeclidinium (Incruse Ellipta)
  • Glycopyrrolate (Seebri)
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SLIDE 15

Tiotropium

  • Long Acting anti

muscarinic

  • Handihaler is once daily

dosing

  • Significant clinical

benefit

  • Respimat dose
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SLIDE 16

Umeclidinium

  • Long acting anti

muscarinic

  • Once daily dosing
  • Longer duration of

action

  • Causes relaxation of

airway muscle, improved lung function and decreased mucus secretion

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SLIDE 17

Glycopyrrolate

  • Long acting anti

muscarinic

  • Once daily dosing
  • Long term maintenance

treatment

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SLIDE 18

Combination of LABA and LAMA

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SLIDE 19

Combination therapy LAMA and LABA

  • Umeclidium and

vilanterol (Anoro Ellipta)

  • Once daily dosing
  • Glycopyrrolate and

Vilanterol (Ultibro)

  • Once daily dosing
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SLIDE 20

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
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SLIDE 21

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
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SLIDE 22

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
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SLIDE 23

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?
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SLIDE 24

Mucolytics

  • Carbosysteine
  • Available as cough

bottle Exputex

  • Dose
  • Erdosteine Capsules

300mg twice daily for max 10 days

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SLIDE 25

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!!

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SLIDE 26

References

  • Copdfoundation.org
  • Copd society
  • Medline plus
  • Nhlibi.nih.gov
  • Healthline.com
  • Nhs.uk/copd
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SLIDE 27
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SLIDE 28