respiratory diseases and infections · 2020. 7. 1. · (pharynx) and voice box (larynx), and enters...

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Funcon of airways Asthma COPD Pneumonia COVID-19 Influenza CCF and Chronic Airways disease Importance of using puffers correctly Nebulisers Issue 9, Version 1 1 Copyright © Meditrax 2020 “This material is copyright and the property of Meditrax the proprietor of the copyright. The material is loaned to the user on the condion that it is not copied in whole or part without the prior wrien consent of the owner of the copyright. When the purpose of the loan has expired, the material is to be returned to Meditrax.” Meditrax is a registered trademark of Manrex Pty Ltd t/as Meditrax. RESPIRATORY DISEASES AND INFECTIONS JUNE 2020 THE RESPITRATORY SYSTEM Some of the funcons of the respiratory system are to: Obtain oxygen from the atmosphere for use in the body Excrete carbon dioxide into the atmosphere. Carbon dioxide is a waste product which must regularly be removed. Guard against foreign material entering the body and therefore reduce the risk of infecon. This is done with cilia (microscopic hair-like structures) and mucus producon. The lungs are a vital organ found in the chest. The air we breathe enters the nose and mouth, flows through the throat (pharynx) and voice box (larynx), and enters the windpipe (trachea). The trachea divides into hollow tubes called bronchi. These then divide further into smaller hollow tubes called bronchioles. At the end of the smallest bronchioles are ny air sacs called alveoli. These are where oxygen enters the body, and where carbon dioxide can leave the blood. TOPICS COVERED

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Page 1: RESPIRATORY DISEASES AND INFECTIONS · 2020. 7. 1. · (pharynx) and voice box (larynx), and enters the windpipe (trachea). The trachea divides into hollow tubes called bronchi. These

Function of airwaysAsthmaCOPD

Pneumonia

COVID-19Influenza

CCF and Chronic Airways diseaseImportance of using puffers correctly

Nebulisers

Issue 9, Version 1

1

Copyright © Meditrax 2020 “This material is copyright and the property of Meditrax the proprietor of the copyright. The material is loaned to theuser on the condition that it is not copied in whole or part without the prior written consent of the owner of the copyright. When the purpose of the

loan has expired, the material is to be returned to Meditrax.” Meditrax is a registered trademark of Manrex Pty Ltd t/as Meditrax.

RESPIRATORY DISEASES AND INFECTIONS JUNE 2020

THE RESPITRATORY SYSTEM

Some of the functions of the respiratory system are to:• Obtain oxygen from the atmosphere for use in the body• Excrete carbon dioxide into the atmosphere. Carbon

dioxide is a waste product which must regularly be removed.

• Guard against foreign material entering the body and therefore reduce the risk of infection. This is done with cilia (microscopic hair-like structures) and mucus production.

The lungs are a vital organ found in the chest. The air we breathe enters the nose

and mouth, flows through the throat (pharynx) and voice box (larynx), and

enters the windpipe (trachea).

The trachea divides into hollow tubes called bronchi. These then divide

further into smaller hollow tubes called bronchioles.

At the end of the smallest bronchioles

are tiny air sacs called alveoli. These are where oxygen enters the body, and where

carbon dioxide can leave the blood.

TOPICS COVERED

Page 2: RESPIRATORY DISEASES AND INFECTIONS · 2020. 7. 1. · (pharynx) and voice box (larynx), and enters the windpipe (trachea). The trachea divides into hollow tubes called bronchi. These

Copyright © Meditrax 2020 “This material is copyright and the property of Meditrax the proprietor of the copyright. The material is loaned to theuser on the condition that it is not copied in whole or part without the prior written consent of the owner of the copyright. When the purpose of the

loan has expired, the material is to be returned to Meditrax.” Meditrax is a registered trademark of Manrex Pty Ltd t/as Meditrax.

2

Asthma is a chronic lung condition – it can’t be cured but can be controlled well with a good management plan. People with asthma have increased sensitivity to certain triggers, which cause a ‘flare up’. This causes narrowing of muscles around the airway (bronchoconstriction), airways swelling, and increased mucus, which lead to breathing difficulty. Each person with asthma may have different triggers which causes their asthma symptoms, however some common triggers include:• Infections• Breathing in cold air, humidity, allergens, irritants, smoke• Exercise or physical activity• Foods or food additives• Stress/anxiety• Reflux• Medications (beta-blockers, aspirin, NSAIDs)• Latex

ASTHMA

RESPIRATORY DISEASES AND INFECTIONS JUNE 2020

People with asthma which is not under good control often feel like

their chest is tight or heavy and they can’t get a good breath in.

This may feel like an elephant is standing on their chest!

It is important to focus on controlling asthma with medications

rather than avoiding certain triggers that may limit lifestyle such as physical activity– for most people triggers are only a concern if asthma is not well managed with medication. The airway

constriction in asthma is reversible when treated with medications

that open up the airways.

Asthma can be either long-standing (from childhood) or can occur later in life.

Many older people with asthma have not been diagnosed as they assume their breathing

problems may be related to age, other medical conditions, lack of fitness or being overweight.

It is important for respiratory symptoms to be assessed and asthma diagnosed where

appropriate, as approximately 60% of deaths from asthma in Australia occur in people over 65 years.

Page 3: RESPIRATORY DISEASES AND INFECTIONS · 2020. 7. 1. · (pharynx) and voice box (larynx), and enters the windpipe (trachea). The trachea divides into hollow tubes called bronchi. These

Copyright © Meditrax 2020 “This material is copyright and the property of Meditrax the proprietor of the copyright. The material is loaned to theuser on the condition that it is not copied in whole or part without the prior written consent of the owner of the copyright. When the purpose of the

loan has expired, the material is to be returned to Meditrax.” Meditrax is a registered trademark of Manrex Pty Ltd t/as Meditrax.

3

Symptoms of AsthmaBreathlessness/shortness of breath

Wheezing Tight feeling in the chest

Cough (mostly dry, worse at night and in the morning)

An ASTHMA ACTION PLAN is recommened

Management of Asthma

This is a set of instructions written with the doctor to assist with control of symptoms.

It outlines:→ What medication to take

→ How to recognise worsening symptoms

→ What to do when symptoms worsen

→ What to do in case of asthma attack

Treatment of asthma mainly involves the use of:

• inhaled bronchodilators (open airways) – initially with short-acting agents (SABAs) and if necessary with addition of inhaled long-acting agents (LABA medications), as well as:

• inhaled corticosteroids (ICS medications) to reduce airway inflammation and are usually added as a second step if a short-acting LABA medication is inadequate to control symptoms).

If an adult with confirmed severe asthma continues to experience frequent symptoms or flare-ups despite optimisation of inhaler technique and adherence, and treatment of comorbidities, a trial of add-on treatment with tiotropium (LAMA) can be considered

in primary care before referring for specialist assessment for other treatments like monoclonal antibody therapy.

RESPIRATORY DISEASES AND INFECTIONS JUNE 2020

Page 4: RESPIRATORY DISEASES AND INFECTIONS · 2020. 7. 1. · (pharynx) and voice box (larynx), and enters the windpipe (trachea). The trachea divides into hollow tubes called bronchi. These

Copyright © Meditrax 2020 “This material is copyright and the property of Meditrax the proprietor of the copyright. The material is loaned to theuser on the condition that it is not copied in whole or part without the prior written consent of the owner of the copyright. When the purpose of the

loan has expired, the material is to be returned to Meditrax.” Meditrax is a registered trademark of Manrex Pty Ltd t/as Meditrax.

4

Chronic obstructive pulmonary disease (COPD)

COPD is an umbrella term used to describe respiratory diseases which involve airflow limitation which, unlike asthma, is not fully reversible.

It includes conditions such as:

• emphysema (alveoli are damaged and stretched),

• chronic bronchitis (inflammation causes chronic cough and mucous), and

• chronic asthma (chronic inflammation may permanently restrict airflow).

It is a progressive disease which can be treated but not cured.

Approximately 30% of people aged 75 years and over in Australia have COPD.

Causes

• Cigarette smoking is the single largest cause of COPD in the western world.

However approximately 20% of people with COPD in Australia have never smoked.

• Environmental factors – secondhand exposure to smoke, and exposure to dust or organic materials, or air pollution.

• Genetic factors – Alpha-1 Antitrypsin Deficiency (AATD) is a genetic risk factor for emphysema. Without the Alpha-1 Antitrypsin protein, white blood cells begin to harm the lungs and deterioration of lung function occurs.

Symptoms of COPDBreathlessness/shortness of breath

Frequent coughing (increasing mucus as disease progresses)Wheezing

Fatigue

RESPIRATORY DISEASES AND INFECTIONS JUNE 2020

Page 5: RESPIRATORY DISEASES AND INFECTIONS · 2020. 7. 1. · (pharynx) and voice box (larynx), and enters the windpipe (trachea). The trachea divides into hollow tubes called bronchi. These

Copyright © Meditrax 2020 “This material is copyright and the property of Meditrax the proprietor of the copyright. The material is loaned to theuser on the condition that it is not copied in whole or part without the prior written consent of the owner of the copyright. When the purpose of the

loan has expired, the material is to be returned to Meditrax.” Meditrax is a registered trademark of Manrex Pty Ltd t/as Meditrax.

5

IT’S NEVER TOO LATE TO QUIT SMOKING!!

COPD progression is slowed when smoking is ceased, even in advanced disease

Manafement of COPD

The aim of treatment is to reduce symptoms, improve quality of life, increase capacity for exercise, and reduce hospital admissions.

Treatment includes

• Long-acting bronchodilators (LABA and LAMA medications alone or in combination) are used in COPD for patients with ongoing symptoms despite treatment with optimally used short acting bronchodilators (SABA medications).

• If suitable, an inhaled corticosteroid (ICS) may be added, however use may be associated with increased risk of respiratory infections including pneumonia and the prescriber must assess the benefit of treatment against this risk.

• Flare-up medications such as antibiotics may be required for infective exacerbations, as well as short courses of oral corticosteroids (e.g. prednisolone).

• Pulmonary rehabilitation – a program including exercise, education and support from doctors, nurses, physiotherapists and other specialists.

• Regular immunisation against influenza (annually) and pneumonia (can be repeated once after 5 years)

• Oxygen therapy – for those with advanced lung diseaseunable to absorb sufficient oxygen for vital organs

SMOKING CESSATION

INHALED MEDICATIONS

A COPD ACTION PLAN

is recommened

RESPIRATORY DISEASES AND INFECTIONS JUNE 2020

Page 6: RESPIRATORY DISEASES AND INFECTIONS · 2020. 7. 1. · (pharynx) and voice box (larynx), and enters the windpipe (trachea). The trachea divides into hollow tubes called bronchi. These

Copyright © Meditrax 2020 “This material is copyright and the property of Meditrax the proprietor of the copyright. The material is loaned to theuser on the condition that it is not copied in whole or part without the prior written consent of the owner of the copyright. When the purpose of the

loan has expired, the material is to be returned to Meditrax.” Meditrax is a registered trademark of Manrex Pty Ltd t/as Meditrax.

6

COPD ACTION PLAN

This is a guide to help recognise when symptoms change and what action should be taken.

The Lung Foundation provides a template for devising a COPD Action Planhttps://lungfoundation.com.au/wp-content/uploads/2018/09/Informa-

tion-paper-COPD-Action-Plan-Feb2019.pdf

This may be incorporated into a resident’s care plan and medications may be prescribed for PRN commencement on

confirmation with the GP when symptoms are worsening, ensuring prompt treatment with GP follow-up which may reduce the risk of

rapid deterioration and hospitalization.

ASTHMA- COPD OVERLAP SYNDROME

Approximately 20% of people with COPD also have asthma and this overlap syndrome is associated with a higher risk and mortality rate than with either condition alone, due to more symptoms, more flare-ups, and there is a greater need for health care interventions.

Specialist referral may be needed if there is doubt about the diagnosis, and to optimise treatment.

Treatment of residents with asthma–COPD overlap involves long-term inhaled corticosteroid (ICS) treatment to reduce the risk of asthma flare-ups.

Most residents should also have a trial of a long-acting beta2 agonist (LABA) and/or long-acting muscarinic antagonist (LAMA).

The use of LABAs or LAMAs without concomitant ICS should be avoided in patients with any features of asthma, or a history of asthma.

RESPIRATORY DISEASES AND INFECTIONS JUNE 2020

RESPIRATORY DISEASES AND INFECTIONS JUNE 2020

Page 7: RESPIRATORY DISEASES AND INFECTIONS · 2020. 7. 1. · (pharynx) and voice box (larynx), and enters the windpipe (trachea). The trachea divides into hollow tubes called bronchi. These

Copyright © Meditrax 2020 “This material is copyright and the property of Meditrax the proprietor of the copyright. The material is loaned to theuser on the condition that it is not copied in whole or part without the prior written consent of the owner of the copyright. When the purpose of the

loan has expired, the material is to be returned to Meditrax.” Meditrax is a registered trademark of Manrex Pty Ltd t/as Meditrax.

7

respiratory infections

Further information about potential contraindications to vaccination can be accessed at:

https://immunisationhandbook.health.gov.au/vaccine-preventable-diseases/influenza-flu – Contraindications and Precautions.

Respiratory infections may affect

the upper airway, lower airway,

and/or the lung itself.

• Infections may be caused by a virus, or bacteria

• Respiratory infections aggravate asthma and COPD, and are a common cause of exacerbations of these diseases.

• In asthma, as most infective exacerbations are caused by a virus, antibiotics are usually not needed and should only be used for specific infections.

• In COPD, as bacteria may be involved as the primary, or the secondary cause in 50% of exacerbations, antibiotics are frequently used.

• Pneumonia is infection of the lungs, and the elderly are at particular risk. Each year pneumonia accounts for more than 40 000 hospital admissions in Australia.

• Influenza is viral infection and may occur sporadically at any time of the year but epidemics are usually seasonal.

Older people are at increased risk of serious complications, including primary viral pneumonia, secondary bacterial pneumonia, exacerbation of

chronic lung and heart disease, and death.

• Residents of aged care facilities are at particular risk due to their advanced age and coexisting medical conditions, and importantly due to close living conditions which increases the risk of infection spread. Visitors and staff may commonly introduce the influenza virus resulting in an outbreak, and together with the risk of COVID-19 infection, it is important to ensure all steps are taken to minimise the risk of these infections in facilities. For this reason it has been made mandatory for all staff and visitors attending facilities to be vaccinated against influenza in 2020.

• The only absolute contraindication to influenza vaccines is anaphylaxis after a previous dose of any influenza vaccine or due to any component of an influenza vaccine. People with egg allergy, including a history of anaphylaxis to eggs, can be safely vaccinated with influenza vaccines.

RESPIRATORY DISEASES AND INFECTIONS JUNE 2020

Page 8: RESPIRATORY DISEASES AND INFECTIONS · 2020. 7. 1. · (pharynx) and voice box (larynx), and enters the windpipe (trachea). The trachea divides into hollow tubes called bronchi. These

Copyright © Meditrax 2020 “This material is copyright and the property of Meditrax the proprietor of the copyright. The material is loaned to theuser on the condition that it is not copied in whole or part without the prior written consent of the owner of the copyright. When the purpose of the

loan has expired, the material is to be returned to Meditrax.” Meditrax is a registered trademark of Manrex Pty Ltd t/as Meditrax.

8

COVID-19

Coronavirus disease (COVID-19) is an infectious disease caused by a new strain of coronavirus (SARS-CoV-2).

• Causes respiratory illness (like the flu)

• Spreads primarily through contact with an infected person

COVID-19 can cause lung complications such as:• Pneumonia• Acute respiratory distress syndrome (ARDS)• Sepsis

With COVID-19 pneumonia, the small air sacs where oxygen exchange occurs in the lungs become filled with fluid and inflamed, causing breathing difficulties which can be severe enough to require treatment with oxygen or a ventilator.

Both lungs are usually affected. The pneumonia may progress to ARDS which is a form of lung failure and may be fatal, however for people who survive there may be lasting scarring of the lungs.

The infection can spread into the bloodstream causing sepsis which can lead to the lungs, heart and other organs shutting down.

Residents of residential aged care facilities are at increased risk of COVID-19 infection, particularly those who are immune suppressed or who have underlying chronic medical conditions such as respiratory disease or heart disease, and they are more vulnerable to serious complications if they do become infected.

Avoiding exposure is the single most important measure for preventing COVID-19

RESPIRATORY DISEASES AND INFECTIONS JUNE 2020

FEVER COUGH SORE THROAT SOB

Page 9: RESPIRATORY DISEASES AND INFECTIONS · 2020. 7. 1. · (pharynx) and voice box (larynx), and enters the windpipe (trachea). The trachea divides into hollow tubes called bronchi. These

Copyright © Meditrax 2020 “This material is copyright and the property of Meditrax the proprietor of the copyright. The material is loaned to theuser on the condition that it is not copied in whole or part without the prior written consent of the owner of the copyright. When the purpose of the

loan has expired, the material is to be returned to Meditrax.” Meditrax is a registered trademark of Manrex Pty Ltd t/as Meditrax.

9

Facility management of COVID-19

• Implement measures to prevent introduction of COVID-19 into their facility (e.g. hand hygiene, restricted entry, etc.)

• Be prepared to manage potential outbreaks as detailed in the Australian Department of Health’s COVID-19 guidelines for outbreaks in residential care facilities

See Medi-Learn topic Preventing Hospitalisation during COVID-19 for further information about managing

residents with Congestive Cardiac Failure and other conditions, and for symptom management in COVID-19

infection.

For residents who remain well, it is also important to

manage their chronic medical conditions optimally at the

facility to PREVENT the need for hospitalization.

1. Optimise inhaled therapy

• Metered dose inhalers (MDIs) with spacers are the most effective way to deliver medications for asthma or COPD. Evidence demonstrates delivery to the airways is improved with the use of a spacer device, even where technique is good. ALL residents should be encouraged to use a SPACER device.

Optimise management of residents with chronic respiratory management

90% of Australians do not use their inhalers correctly according to the National Asthma

Council

• Ensure correct MDI administration technique is known and used. Good technique is associated with fewer symptoms, increased lung function, and better quality of life.

• To maximise benefit, administer SABA relievers (rapidly open airways) prior to other inhalers if prescribed for use at the same time.

• Assess the inspiratory effort for residents using dry powder inhalers (DPIs) to ensure it is adequate to effectively inhale the medication from the device.

i.e. Can the resident inhale deeply enough to breathe in the medication?

RESPIRATORY DISEASES AND INFECTIONS JUNE 2020

Page 10: RESPIRATORY DISEASES AND INFECTIONS · 2020. 7. 1. · (pharynx) and voice box (larynx), and enters the windpipe (trachea). The trachea divides into hollow tubes called bronchi. These

Copyright © Meditrax 2020 “This material is copyright and the property of Meditrax the proprietor of the copyright. The material is loaned to theuser on the condition that it is not copied in whole or part without the prior written consent of the owner of the copyright. When the purpose of the

loan has expired, the material is to be returned to Meditrax.” Meditrax is a registered trademark of Manrex Pty Ltd t/as Meditrax.

10

2. Avoid the use of nebulisers

Nebulisers generate a high level of aerolised particles that spread widely and can infect staff and other residents.

When nebulisers are the only appropriate therapy, administer if possible in a negative pressure or single room using contact, droplet and airborne precautions.

Optimise management of residents with chronic respiratory management

3. Cleaning Devices

Ensure inhaled devices and spacers are regularly cleaned after each use and are stored separated from other medications - preferably in sealed bags/containers for each resident in the medication trolley.

CLEANING OF INHALERS

• Wipe all inhalers with a clean, dry tissue after use

• For dry powder inhalers (DPIs)- do not wash any part of the device or get it wet

• For MDIs, regularly remove the metal canister (do not wash this) and wash the plastic casing and cap with running warm water for at least 30 seconds. Allow to air dry.

Please refer to Meditrax Resource

respiratory device management: technique and maintenance

RESPIRATORY DISEASES AND INFECTIONS JUNE 2020

available on Meditrax website - QUM Resources, for distribution by managers