COPD Therapeutics Lecture Deck PDF

Chronic Obstructive Pulmonary Disease (COPD) Therapeutics Jeffrey Wong, BScPharm, ACPR, PharmD GLOBAL INITIATIVE FOR CHRONIC OBSTRUCTIVE LUNG DISEASE (GOLD)  Learning Objectives Assess a patient’s COPD categorization and mortality risk based on symptoms and functional s...

Chronic Obstructive Pulmonary Disease (COPD) Therapeutics Jeffrey Wong, BScPharm, ACPR, PharmD GLOBAL INITIATIVE FOR CHRONIC OBSTRUCTIVE LUNG DISEASE (GOLD)  Learning Objectives Assess a patient’s COPD categorization and mortality risk based on symptoms and functional status Describe the role of the major classes of drugs used to treat COPD Devise a patient-specific regimen for COPD Discuss therapeutic controversies in the management of patients with COPD Manage a patient with an acute exacerbation of COPD Review the options for smoking cessation  Functional Assessment Scales: Modified British Medical Research Council Questionnaire (mMRC) Grade Description of Breathlessness 0 I only get breathless with strenuous exercise. 1 I get short of breath when hurrying on level ground or walking up a slight hill. 2 I walk slower than people of the same age because of breathlessness, or I have to stop for breath when walking at my own pace on level ground. 3 I stop for breath after walking about 100 meters or after a few minutes on level ground. 4 I am too breathless to leave the house or I am breathless when dressing or undressing  Functional Assessment Scales: COPD Assessment Test (CAT) www.catestonline.org/ english/indexEN.htm ABCD Assessment Tool Mortality Prediction Rule: BODE Index New Engl J Med 2004;350:1005-12. B = BMI O = degree airflow obstruction D = degree of dyspnea E = exercise capacity Mortality Prediction Rule: BODE Index New Engl J Med 2004;350:1005-12. BODE score; Approximate 52 month mortality 0-2; 80% 3-4; 67% 5-6; 35% 7-10; 20%  What is a COPD Exacerbation? An acute worsening of respiratory symptoms that is beyond normal day-to-day variations and leads to a change in therapy. Usually associated with acute changes in a patient’s symptoms: – Cough increases in frequency and severity – Sputum production increases in volume and/or changes character – Dyspnea increases  What is a COPD exacerbation? Results in frequent physicians’ office visits, increased ER use, increased hospitalization days, increase in cost Increased risk of death, more rapid decline in lung function, and reduced QOL Rate can be as high as 1.4 acute exacerbations/year for patients with severe COPD on triple inhaler therapy In severe COPD exacerbations, 30-day mortality is higher than with heart attacks N Engl J Med 2011;365:753-4.; Ann Intern Med. 2007 Apr 17;146(8):545-55.; Ann Intern Med. 2006 Jun 20;144(12):894-903.; Chest. 2001 Feb;119(2):344-52.; Thorax. 2002 Oct;57(10):847-52.; Am J Respir Crit Care Med. 1998;157:1418–1422.; Thorax. 2005;60:925–931; THERAPEUTIC FRAMEWORK Therapeutic Strategies in COPD Chest. 2023 Nov;164(5):1159-1183. NON-PHARMACOLOGICAL THERAPIES  Education and Self-Management Patient coaching is a major component of the chronic care model Motivate, engage and coach patient to adopt healthy behaviours and develop skills to manage the disease – Address modifiable risk factors – Monitor symptoms and complications – Adherence – Inhaler technique  Reduce Risk Factors Reduce exposure to inhaled irritants Smoking cessation single most effective intervention to ¯ risk of developing COPD and influence progression 80% of deaths from COPD due to smoking Every smoker should be offered treatment and counselling regularly www.hc-sc.gc.ca/hc-ps/tobac-tabac/legislation/label-etiquette/pulmon-eng.php#fn5  Pulmonary Rehabilitation Common components include exercise (twice weekly), smoking cessation, nutrition counseling, education, self-management Improves exercise capacity, breathlessness Prevents hospitalization if initiated shortly (