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Critical analysis, Constructing an argument,
Challenging assumptions, Balanced through judgement and conclusion.
Harvard referencing method
COPD Management Update Dec, 2016 Jane Young Learning outcomes • Impacts of COPD • Review local and national COPD guidelines. • Pharmacological management, including inhaler technique. • Non-pharmacological management. • Managing COPD patient in practice. Chronic Obstructive Pulmonary Disease : COPD ‘A common preventable and treatable disease. as a disease state characterised by persistent airflow limitation that is not fully reversible, is usually progressive, and is associated with an abnormal inflammatory response of the lungs to inhaled noxious particles or gases. Exacerbations and comorbidities contribute to the overall severity in individual studies’ (GOLD,2014) Emphysema and Chronic Bronchitis. Pathophysiology ‘Abnormal inflammatory response’ – expiratory flow limitation as airway wall becomes damaged and/or excessive mucus production. Hyper-inflation Air trapping ….but it extends much further than just the lungs.. Asthma-COPD Overlap Syndrome • Recently coined by GINA and GOLD (2015) ‘persistent airflow limitation with several features usually associated with asthma and several usually associated with COPD’ Accounts for approximately 15-20% of COPD patients. Outcomes for pts with ACOS tend to be worse than if one disease. If assessment indicates ACOS – start Asthma treatment, until further investigation. Refer to GINA/GOLD guidelines (2015) Causes Smoking Passive Smoking Occupational exposure Open fire cooking Air pollution Impacts of COPD • 1 million people in the UK are diagnosed with COPD, but many are undiagnosed. • 5th biggest killer in the UK. 3rd biggest killer worldwide. • Second most common reason for emergency hospital admissions (UK), which are often frequent and unnecessary. (10% receive diagnosis during admission). • Mortality rates are far higher in the UK than the rest of Europe (BTS,2006). • Mortality set to rise 30% over the next 10 years (worldwide) • Equal spread between men and women. Impacts for patients • Over 50% of patients diagnosed with COPD are below retirement age. • COPD affects lower social classes. • 15% of those admitted to hospital with a Exacerbation of COPD will die within 3 months. • Disability life years adjusted measure state of population health compared to a normative goal. • Sum of two – Years of life lost due to premature mortality (YLL’s) and Years lived with disability (YLD’s) – an absolute measure of health loss, count how many years of health life are lost due to poor health. The 10 most common causes of disability-adjusted life-years (DALYs) lost worldwide in 2008.Source: World Health Organization World Health Statistics 2011. DALYs lost to Worldwide WHO European Region Lower respiratory infections 79 million (5.4%) 2.2 million (1.5%) HIV/AIDS 65 million (4.4%) 2.6 million (1.8%) Ischaemic heart disease 64 million (4.4%) 16.0 million (11.3%) Diarrhoeal diseases 56 million (3.8%) 1.1 million (0.7%) Cerebrovascular disease 48 million (3.3%) 9.3 million (6.4%) Road traffic accidents 45 million (3.1%) 3.4 million (2.4%) COPD 33 million (2.3%) 2.9 million (2.0%) Tuberculosis 29 million (2.0%) 1.7 million (1.2%) Diabetes mellitus 22 million (1.5%) 2.6 million (1.8%) Trachea/bronchus/lung cancer 13 million (0.9%) 3.2 million (2.2%) DALY’s (Symptoms) • Breathlessness • Cough • Reduce functional ability – Physical • Psychological – anxiety/depression/isolation • Fatigue • Reduced appetite COPD Value Pyramid Quality of Life Years Adjusted • Considers quantity and quality of life (to the patient) and the cost of the medication • Need to treat COPD early – flu jab, smoking cessation and PR • Pharmacological interventions are costly BNF (2015) • Gastro-intestinal system 95,337.5 £488,800.9 • Cardiovascular system 316,520.3 £1,090,156.7 • Respiratory system 70,555.8 £1,141,776.1 • Central nervous system 201,335.1 £1,927,020.7 • Infections 46,222.6 £250,286.8 • Endocrine system 103,042.2 £1,358,043.6 Prescription Cost Analysis England 2015 HSIC Identifying undiagnosed patients • BLF report highlight missing millions @ 2 million. • Case finding or not??? • National Guidelines recommend: COPD should be consider in anyone over 35 years of age who present with one risk factor and one or more symptoms post bronch spiro. Management/Guidelines • COPD is a chronic disease, that can and should be largely managed in the community (Kings Fund, 2013) • In recognition of the symptoms there has been a change in focus upon the guidelines: • National – NICE (2011) – disease driven • International GOLD (2015) – combined disease/symptom. References • Battle for Breath report (BLF, 2016) • Health and Social care Information Centre (2015) Prescription cost analysis England 2015 http://digital.nhs.uk/catalogue/PUB20200/pres-cost-analeng-2015-rep.pdf • British Thoracic Society (2006) The Burden of Lung disease report. • World Health Organisation (2015)
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