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