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Management of stable COPD Sally Hull GP Tower Hamlets Senior

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Management of stable COPD Sally Hull GP Tower Hamlets Senior clinical lecturer, QMUL Cannot prescribe nebulisers Some patients buy them by choice Prescription ... – PowerPoint PPT presentation

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Title: Management of stable COPD Sally Hull GP Tower Hamlets Senior


1
Management of stable COPD

Sally Hull GP Tower HamletsSenior clinical
lecturer, QMUL
2
To cover.
  • Managing symptoms
  • Annual review template
  • When to start which medicines
  • Rescue packs
  • Self management plans
  • Treatment dilemmas

3
  • The Tower Hamlets care package for COPD
    incentivises practices to
  • Identify undiagnosed COPD cases
  • Undertake annual review on those with mild,
    moderate and severe COPD (predicted FEV1 gt30)
    including housebound patients.
  • Six monthly reviews on patients with very severe
    COPD (predicted FEV1 lt30) including housebound
    patients.
  • Admission avoidance, using prompt referral to the
    community respiratory service
  • Referral into pulmonary rehabilitation.
  • The template prompts support these aspects of the
    care package, along with other items outlined in
    the BTS and NICE guidelines for COPD

4
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5
Template information boxes
6
Smoking advice
7
On COPD register and still smoking by ethnicity
  • adjusted by age, sex, PCT, clustered by GP
    practice.

8
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9
NICE 2010, changes to severity classification
10
Inhaled medications for COPD
National Institute for Clinical Excellence. 2004.
11
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13
Theophylline preparations
  • How does theophylline work?
  • Relax smooth muscle
  • Increase diaphragmatic strength
  • Improve muco-ciliary clearance
  • Increase cardiac output
  • BUT require regular monitoring, and interact with
    other drugs particularly antibiotics

14
Mucolytic therapy
  • Consider carbocysteine in patients with
    chronic cough and sticky mucous.
  • Some evidence of symptomatic relief

15
Steroids in stable COPD
  • Inhaled steroids are linked to increased risks of
    pneumonia
  • Avoid maintenance use of oral steroids
  • Osteoporosis risk
  • 5mg steroids a day for 3/12 in a year
  • High dose ICS (eg fluticasone gt200mcg 2 puffs
    2bd)

16
Rescue pack
  • Antibiotic 7/7 and oral steroid 10/7
  • Link to self management plan
  • Importance of contact with practice to monitor
    use of rescue meds.

17
Treatments not recommended
  • Anti oxidant supplements
  • Cough mixtures
  • Prophylactic antibiotics

18
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23
Treatment Dilemma 1.
  • 70 year old man with 10 year history of COPD.
  • predicted FEV1 is 60, BM1 21, still smoking
  • On full range of inhaled medications.
  • He has noted increasing cough,
  • He has lost about 4kg in the last 2-3 months.
  • Consider management options

24
Treatment Dilemma 2.
  • Elderly woman of 72 with 12 year history of
    moderate COPD. predicted FEV1 is 50,
  • On full range of inhaled medications.
  • She had a recent admission with a heart attack,
  • She is now on simvastatin, ACEI, aspirin,
    atenolol.
  • Are there any adverse drug interactions to
    consider?

25
Treatment Dilemma 3.
  • A man of 50 with severe COPD (pr FEV1 of 45)
  • He has a rescue pack at home
  • (Amoxycillin 500x21, Prednisolone 30mg 10D)
  • He sees you one Week after finishing this saying
    he still has cough and more sputum than usual.
  • How would you advise him?

26
Treatment Dilemma 4.
  • A man of 80 with moderate COPD (pr FEV1 of 55)
  • Treated himself with a rescue pack for an
    exacerbation following a URTI. He requests a
    visit as remains SOB and legs are swollen.
  • How would you manage him? Immediately and longer
    term?
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