COPD CARE Disease State Management

COPD CARE Disease State ManagementStephanie Gruber, PharmD, BCACPWilliam S Middleton VA Hospital

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


COPD Definition


COPD DefinitionEmphysema

Air Space Enlargement and Destruction of Alveolar Walls leading to bronchiole tubule collapse

Normal Alveoli Emphysema


COPD DefinitionChronic BronchitisInflammation in the bronchial tubes

HealthyInflammation (excess mucus)


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


Disease Burden

The top 10 causes of death. World Health Organization.

COPD is the third leading cause of death worldwide

Deaths (in millions)

Diseases


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%


Diagnosis


COPD Management

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MaintenanceAcute


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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Medications• The choice of medication depends on disease severity

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Quick relief/short‐acting bronchodilators

Long‐term controllers


Rescue Medication/Short‐Acting Bronchodilators

Albuterol(yellow previously)(red currently)

Ipratropium(green)

Albuterol/Ipratropium(orange)


Rescue Medication/Short‐Acting Bronchodilators

Nebulizers


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.


Long-term Inhaled Controllers

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Corticosteroids Beta Agonists

Antimuscarinics


Daily Maintenance Medications/ Long‐term Controllers

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Budesonide/Formoterol(red)

Olodaterol(yellow)

Tiotropium(blue)

Olodaterol/Tiotropium(green)


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.


Medication Administration• Metered Dose Inhaler Instruction

– Video (5 minutes)

• Nebulizer Instruction– Video (~5 minutes)

• Respimat Instruction– Video (7 minutes)

COPD CARE Disease State ManagementStephanie Gruber, PharmD, BCACPWilliam S Middleton VA Hospital

Documents

COPD CARE Disease State Management