A Breath of Fresh Air Treating COPD - Free CE · Chronic Bronchitis Emphysema Asthma. Chronic Bronchitis. Emphysema. Asthma. COPD. Clinically ... Case Study A 45 year old ...
Post on 09-Jun-2018
216 Views
Preview:
Transcript
A Breath of Fresh AirA Breath of Fresh AirTreating COPDTreating COPD
Kip Benko MD FACEP Asst Clinical Professor
University of Pittsburgh School of Medicine
COPD -- What is it exactly?
✦ COPD--Chronic Obstructive Pulmonary Disease-- is a mixture of 3 separate disease processes…..
Chronic BronchitisChronic Bronchitis
EmphysemaEmphysema
AsthmaAsthma
Chronic Bronchitis
Emphysema
Asthma
COPDCOPD
Clinically…✦ Chronic Bronchitis
Group
---Productive cough---Frequent pulmonary
infections---Progressive cardiac and
respiratory failure with edema and weight gain
---In respiratory failure, CO2 & your O2
Clinically…..✦ Emphysema Group
---long history of SOB---occasional purulent
infections---eventual wasting and
respiratory failure
Prevalence
✦ COPD affects 24 million adults in US
✦ Men > Women✦ > 40 yrs of age
….and is the 4th leading cause of death.
Women and COPD
✦ 2007--5th Consecutive year that women outnumber men in deaths attributable to COPD
Direct Cost of COPD 31 Billion Annually in the US in 2004
72.8%72.8% 15%15%
12.2%12.2%
Indirect CostsIndirect Costs
✦ Estimated to be 17 billion in 2004✦ Includes:
--loss of future earnings secondary to morbidity and premature mortality
“ “ I met the Surgeon General…I met the Surgeon General…he offered me a cigarette….!”he offered me a cigarette….!”
Rodney Dangerfield
Risk Factors for COPDRisk Factors for COPD
80%80% 20%20%
All Others
Other Risks for COPD✦ Allergenic Risks are important in some peopleAllergenic Risks are important in some people certain allergenscertain allergens
cause skin reactivity cause IL -3 to make IGE
Lung destroying Abs
Other COPD Risk Factors
✦ Occupational Occupational ExposuresExposures
Other COPD Risk Factors
✦ Genetic/MetabolicGenetic/Metabolic
--Alpha-1 Antitrypsin deficiency
--Deficiencies of anti- oxidants (C & E)
--Tumor necrosis factor alpha
Risk Reduction
✦ First and Foremost, Stop the Smokes!!!Stop the Smokes!!!
Risk Reduction✦ Exercise……
Helps bothSmokers & Non-Smokers!!
Risk Reduction
✦ You will hear more about these….
Making the Diagnosis
COPDCOPD
HistoryHistory Physical Physical ExamExam
CXR, Chest CT, Blood Work & Spirometry
Making the DiagnosisMaking the Diagnosis
COPDCOPD Normal CXRNormal CXR
Making the Diagnosis
Making the Diagnosis
✦ The Gold Standard = SpirometryThe Gold Standard = Spirometry
Making the Diagnosis
Medication Summary
Long Term Control meds continued…..
Quick Hitters! Meds for exacerbations!
Oxygen
✦ Improves survival and quality of life in hypoxemic patients.
Non-Pharmacologic Treatments
✦ Weight & Nutrition Management
✦ Smoking Cessation
Non Pharmacologic Treatments
✦ Pneumococcal Vaccine
✦ Exercise✦ Surgery
Role of the PharmacistRole of the Pharmacist
✦ Assist with smoking cessation
✦ Checking inhaler techniques
✦ Spotting non-compliance, treatment failures and depression
Role of the PharmacistRole of the Pharmacist
✦ Review OTC products and prescribed meds
✦ Reinforce exercise importance
✦ Refer if symptoms appear to be worsening
Case Study
✦ A 45 year old female with a 6 year old daughter arrives at your pharmacy. She has a prescription from an Emergency Department for an albuteral MDI and 5 days of prednisone.
Case Study
✦ You notice that this is her 4th inhaler this month, all from different doctors. You see in your records that she also takes insulin. You also notice cigarettes in her purse. What are the important issues here that need to be addressed?
Important Issues to Address✦ There appears to be poor control of this patients
asthma/COPD. Inquire. ✦ There also appears to “doctor shopping”. Inquire
and inform. ✦ You’re concerned about the interaction that
prednisone has on diabetes. Remind. ✦ You know cigarettes worsen COPD. You also
know the danger of second hand smoke. Educate.
Thanks
top related