copd care disease state management
TRANSCRIPT
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COPD CARE Disease State ManagementStephanie Gruber, PharmD, BCACPWilliam S Middleton VA Hospital
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VETERANS HEALTH ADMINISTRATION
COPD DefinitionCOPD (Chronic Obstructive Pulmonary Disease)
A common, preventable and treatable lung disease characterized by:
• Airflow Limitation• Abnormal Inflammatory Response• Increased mucus production
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VETERANS HEALTH ADMINISTRATION
COPD Definition
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VETERANS HEALTH ADMINISTRATION
COPD DefinitionEmphysema
Air Space Enlargement and Destruction of Alveolar Walls leading to bronchiole tubule collapse
Normal Alveoli Emphysema
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VETERANS HEALTH ADMINISTRATION
COPD DefinitionChronic BronchitisInflammation in the bronchial tubes
HealthyInflammation (excess mucus)
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VETERANS HEALTH ADMINISTRATION
COPD DefinitionAsthmaAsthma COPD Overlap
Syndrome (ACOS)
• Persistent airflow limitation with features associated with asthma and COPD
• ACOS is therefore identified in clinical practice by the features that it shares with both asthma and COPD
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VETERANS HEALTH ADMINISTRATION
Disease Burden
The top 10 causes of death. World Health Organization.
COPD is the third leading cause of death worldwide
Deaths (in millions)
Diseases
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VETERANS HEALTH ADMINISTRATION
Disease Burden
Deaths from Chronic Obstructive Pulmonary Disease. www.cdc.gov
Mortality In 2005, 1:20 deaths had COPD as the underlying
cause
Cost $6,000 annually for each COPD patient
Readmission Rates:Setting 30‐day readmission rate
COPD 17.9%
All conditions 13.1%
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VETERANS HEALTH ADMINISTRATION
Diagnosis
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VETERANS HEALTH ADMINISTRATION
COPD Management
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MaintenanceAcute
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VETERANS HEALTH ADMINISTRATION
Maintenance: Non-Medications• Tobacco Cessation• Immunizations
– Influenza, Pneumococcal, TdaP
• Pulmonary Rehabilitation• Respiratory Therapy• Telehealth Monitoring• Comorbidity Management
– Heart disease, osteoporosis, cancer, mental health, diabetes, acid reflux, nutrition, sleep apnea
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VETERANS HEALTH ADMINISTRATION
Medications• The choice of medication depends on disease severity
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Quick relief/short‐acting bronchodilators
Long‐term controllers
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VETERANS HEALTH ADMINISTRATION
Rescue Medication/Short‐Acting Bronchodilators
Albuterol(yellow previously)(red currently)
Ipratropium(green)
Albuterol/Ipratropium(orange)
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VETERANS HEALTH ADMINISTRATION
Rescue Medication/Short‐Acting Bronchodilators
Nebulizers
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VETERANS HEALTH ADMINISTRATION
Quick Relief/Short-Acting Bronchodilators
• What they do– Relax and open up the airways quickly – Prevent and reduce symptoms– Prescribed either scheduled every 4‐6 hours OR as needed for symptoms
• When to expect benefit– Albuterol: within 5‐15 minutes– Ipratropium: does not work as fast as albuterol
• How long does medication last– Albuterol: 4‐6 hours– Ipratropium: 6‐8 hours
• Side effects– Albuterol: palpitations, rapid heart rate, tremor, or nervousness– Ipratropium: dry mouth, urinary retention
Be sure to check for overuse! That is a sign
that COPD is not well‐controlled.
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VETERANS HEALTH ADMINISTRATION
Long-term Inhaled Controllers
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Corticosteroids Beta Agonists
Antimuscarinics
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VETERANS HEALTH ADMINISTRATION
Daily Maintenance Medications/ Long‐term Controllers
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Budesonide/Formoterol(red)
Olodaterol(yellow)
Tiotropium(blue)
Olodaterol/Tiotropium(green)
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VETERANS HEALTH ADMINISTRATION
Long-term Controllers
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• What they do– Relax and open up the airways slowly – Decrease inflammation to improve symptoms– Improve lung function, quality of life, and decrease flare‐ups
• When to expect benefit– Up to a couple of weeks for full effect
• How long does medication last– Budesonide/Formoterol: 12 hours– Olodaterol: 24 hours– Tiotropium: 24 hours
• Side effects– Budesonide/Formoterol: oral fungal infection (thrush), hoarseness – Olodaterol: palpitations, rapid heart rate, tremor, or nervousness– Tiotropium: dry mouth, urinary retention (rare)
Be sure to tell patients they need to rinse and spit with water after
using their budesonide/ formoterol.
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VETERANS HEALTH ADMINISTRATION
Medication Administration• Metered Dose Inhaler Instruction
– Video (5 minutes)
• Nebulizer Instruction– Video (~5 minutes)
• Respimat Instruction– Video (7 minutes)
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COPD CARE Disease State ManagementStephanie Gruber, PharmD, BCACPWilliam S Middleton VA Hospital