Typical Symptoms

few symptoms breathless on moderate exertion recurrent chest infections little or no effect on daily activities

increasing dyspnoea breathless walking on level ground increasing limitation of daily activities cough and sputum production infections requiring steroids

dyspnoea on minimal exertion daily activities severely curtailed experiencing regular sputum production chronic cough

Lung Function FEV1 ≈ 60-80% predicted FEV1 ≈ 40 -59% predicted FEV1 < 40% predicted

MiLd ModEraTE SEVErE

Stepwise Management of Stable CoPd

# Indacaterol should not be used in asthma or mixed airways disease. A differential diagnosis should be made to exclude asthma or mixed airways disease before initiating indacaterol.

+ Roflumilast is not yet available for use in Australia.

June 2012 Awareness Education Support Research

The Australian Lung Foundation PO Box 847 Lutwyche Qld 4030

Free call: 1800 654 301

Website: www.lungfoundation.com.au

Based on COPD-X Plan: Australian and New Zealand Guidelines for the Management of COPD 2006; Australian Therapeutic Guidelines

Non-Pharmacological interventions

Management of stable COPD should centre around

supporting smoking patients to quit. Encouraging physical activity and maintenance of a normal weight range are also important. Pulmonary

rehabilitation is recommended in symptomatic patients.

Pharmacological interventions

The aim of pharmacological treatment may be to treat

symptoms, (ie breathlessness) or to prevent deterioration

(either by decreasing exacerbations or by reducing decline in quality of life) or

both. A stepwise approach is recommended, irrespective of disease severity, until adequate

control has been achieved.

SyMPToM rELiEF: Long acting anticholinergic (tiotropium) and/or long acting beta2agonists (salmeterol, eformoterol or indacaterol#). This may also help to prevent exacerbations. Once tiotropium is commenced, ipratropium bromide should be discontinued.

ExaCErbaTioN PrEVENTioN: (When FEV1 < 50% predicted AND patient has had 2 or more exacerbations in the previous 12 months) inhaled glucocorticoids combined with long-acting beta2agonist (fluticasone/salmeterol or budesonide/eformoterol). LABA monotherapy (eformoterol, salmeterol or indacaterol) should be ceased once combination therapy (ICS/LABA) is initiated.

ShorT-aCTiNg rELiEVEr MEdiCaTioN: salbutamol or terbutaline or ipratropium bromide

Consider roflumilast+ or low dose theophylline

ChECk dEViCE uSagE TEChNiquE aNd adhErENCE aT EaCh ViSiT - Up to 90% of patients don’t use devices correctly

Consider oxygen therapy, surgery, palliative care and advanced care directives

rEFEr To PuLMoNary rEhabiLiTaTioN and consider psychosocial needs, agree written action plan

oPTiMiSE FuNCTioN Encourage physical activity, review nutrition, provide education, develop GP management plan and initiate regular review

CoNSidEr Co-MorbidiTiES especially osteoporosis, coronary disease, lung cancer, anxiety and depression

riSk rEduCTioN Check smoking status, support smoking cessation, recommend annual influenza and pneumococcal vaccine according to immunisation handbook

Vis

it w

ww

.lungfo

undat

ion.c

om

.au a

nd c

lick

on

Profe

ssio

nal

Res

ourc

es t

o fi

nd o

ut

more

or

call

us

on 1

800 6

54 3

01 t

o o

rder

copie

s.

The f

ollo

win

g r

eso

urc

es

hav

e b

een d

eve

loped

by

The A

ust

ralia

n L

ung F

oundation t

o s

upport

dia

gnosi

s and m

anagem

ent

of

CO

PD

.

Patie

nt R

esou

rces

BREATh

E E

ASIE

R:

YO

UR G

UID

E

TO C

OPD

this

DL

flye

r pro

vides

in

troduct

ory

info

rmat

ion o

n C

OPD

, how

you g

et it,

how

it

is d

iagnose

d

and im

port

ant

step

s to

tak

e to

im

pro

ve s

ympto

ms

and s

tay

out

of hosp

ital

.

1

Sav

e yo

ur b

reat

hIn

form

atio

n fo

r peo

ple

rece

ntly

diag

nose

d w

ith C

OPD

Mar

ch 2

010

SAVE Y

OU

R B

REATh

Info

rmat

ion for

peo

ple

rec

ently

dia

gnose

d w

ith C

OPD

– a

short

guid

e to

man

agin

g C

OPD

, in

cludin

g info

rmat

ion o

n m

edic

atio

n,

exer

cise

, die

t an

d q

uitting s

moki

ng.

“Whe

n yo

u ca

n’t b

reat

he...

no

thin

g el

se m

atte

rs”

Nov

embe

r 200

8

Bett

er L

ivin

g w

ith

Chro

nic

Obs

truc

tive

Pulm

onar

y Di

seas

e A

Patie

nt G

uide

Wonder

ing w

hat

is

nex

t?

Main

tain

th

e g

ain

s you

have a

lread

y

ach

ieved

fro

m P

ulm

on

ary

Reh

ab

ilit

ati

on

.

Ask

for

a r

efer

ral to

day

or

conta

ct t

he

Lung

Foundat

ion for

mor

e det

ails

.

To

ll F

ree:

1800 6

54 3

01

Web

site

: w

ww

.lungfo

undat

ion.c

om

.au

Safe

, fu

n a

nd

in

exp

en

sive

Com

munity

bas

ed e

xerc

ise

clas

ses

for

peo

ple

who h

ave

stab

le c

hro

nic

lung c

onditio

ns

Have y

ou

co

mp

lete

d

Pu

lmon

ary

R

eh

abilit

ati

on

?

Lungs

in A

ctio

n is

not

a h

ealth p

rogra

m a

nd in

stru

ctor

s

are

not

train

ed t

o p

rovid

e a

ny m

ed

ical ad

vic

e b

ut

are

tra

ined t

o p

rovid

e a

SA

FE e

xerc

ise e

nvir

on

men

t.

Phon

e yo

ur

loca

l tr

ainer

on:

Ask

you

r m

an

ag

ing

C

lin

icia

n o

r P

hysi

oth

era

pis

t

ab

ou

t Lu

ng

s in

Act

ion

cla

sses.

BETT

ER L

IVIN

G W

ITh

CO

PD

A P

atie

nt

Guid

e – t

his

det

aile

d

han

dbook

pro

vides

all

the

in

form

atio

n p

atie

nts

nee

d t

o

live

bet

ter

with C

OPD

.

Nov

embe

r 20

10

on H

ome

Oxy

gen

Get

ting

Star

ted

GETT

ING

STA

RTED

O

N h

OM

E O

xYG

EN

Im

port

ant

info

rmat

ion

for

those

rec

ently

pre

scribed

hom

e ox

ygen

.

Th

E L

UN

G h

EALT

h C

hECkLI

ST

It t

akes

just

a m

inute

to c

hec

k

the

hea

lth o

f yo

ur

lungs.

Ava

ilable

on-l

ine

in a

n inte

ract

ive

form

at a

t w

ww

.lungfo

undat

ion.c

om

.au o

r in

post

er o

r flye

r fo

rmat

.

CO

PD-x

GU

IDELI

NES

This

on-l

ine

tool pro

vides

bes

t

pra

ctic

e cl

inic

al m

anag

emen

t of

CO

PD in a

sea

rchab

le form

at.

CO

PD-x

Guid

elin

es a

re a

vaila

ble

at

ww

w.c

opdx.

org

.au

CO

PD O

N-L

INE

A c

ompre

hen

sive

on-l

ine

trai

nin

g

dev

eloped

to s

upport

the

role

of

pri

mary

care

nurs

es a

nd o

ther

s

in m

anagem

ent

of

CO

PD

and in

faci

litating s

elf-

managem

ent.

PRIM

ARY

CARE R

ESPI

RAT

ORY

TOO

LkIT

An o

n-l

ine d

eci

sion s

upport

tool,

speci

ally

deve

loped t

o s

um

mari

se

CO

PD

-x G

uid

elin

es

and s

upport

pr

imar

y ca

re p

ract

itio

ner

s in

dia

gnos

is

and m

anag

emen

t of CO

PD.

TARG

ETED

CO

PD C

ASE-F

IND

ING

U

SIN

G C

OPD

SCREEN

ING

DEVIC

ES

A p

rogra

m t

o s

upport

scr

eenin

g

for

CO

PD

incl

udes

train

ing D

VD

,

inst

ruct

ion s

hee

t an

d r

esults

form

.

Th

E C

OPD

-x A

CTIO

N P

LAN

should

be

com

ple

ted b

y th

e cl

inic

ian a

nd

pat

ient

toget

her

. It

hel

ps

the

pat

ient

reco

gnis

e w

hen t

heir

conditio

n

chan

ges

and w

hat

act

ion t

hey

shou

ld

take

. The

CO

PD-x

Act

ion P

lan is

avai

lable

in d

iffe

rent

form

ats.

This

su

mm

ary

card

an

d c

hec

klis

t h

igh

ligh

ts t

he

key

feat

ure

s o

f a p

ulm

on

ary

reh

abili

tati

on

pro

gra

m.

Co

mp

reh

ensi

ve,

evid

ence

-bas

ed in

form

atio

n o

n h

ow

to e

stab

lish

a p

ulm

on

ary

reh

abili

tati

on

pro

gra

m is

ava

ilab

le a

t th

e Pu

lmo

nar

y R

ehab

ilita

tio

n T

oo

lkit

web

site

: ww

w.p

ulm

on

aryr

ehab

.co

m.a

u

A p

ulm

onar

y re

habi

litat

ion

prog

ram

sho

uld

be c

onsi

dere

d fo

r any

pat

ient

who

has

und

erly

ing

chro

nic

lung

dis

ease

and

who

is li

mite

d by

dys

pnoe

a.

Pulm

onar

y re

habi

litat

ion

prog

ram

s re

quir

e a

heal

th p

rofe

ssio

nal w

ho h

as th

e ex

pert

ise

to c

ondu

ct

an e

xerc

ise

prog

ram

and

who

is tr

aine

d in

car

diop

ulm

onar

y re

susc

itat

ion.

Fo

r the

edu

cati

onal

com

pone

nt

of th

e pr

ogra

m, a

mul

tidi

scip

linar

y te

am o

f hea

lth

prof

essi

onal

s m

ay b

e in

volv

ed.

Ob

tain

med

ical

his

tory

Ass

ess

smo

kin

ga

nd

nu

trit

ion

als

tatu

s

Per

form

sp

iro

met

ry

Ass

ess

exer

cise

cap

acit

y

• Six

-Min

ute

Wal

k Te

st

Per

form

two

base

line

6MW

Ts w

ith

at le

ast 3

0 m

inut

es re

st b

etw

een

test

s.

OR

• In

crem

enta

l Sh

utt

le W

alk

Test

Per

form

two

base

line

ISW

Ts w

ith

at le

ast 3

0 m

inut

es re

st b

etw

een

test

s.

Ass

ess

qu

alit

yo

flif

e

• Ch

ron

ic R

esp

irat

ory

Dis

ease

Qu

esti

on

nai

re

OR

• St

Geo

rge’

s R

esp

irat

ory

Qu

esti

on

nai

re

Ass

ess

bre

ath

less

nes

s

• Mo

difi

ed M

edic

al R

esea

rch

Co

un

cil D

ysp

no

ea S

cale

OR

• Mo

difi

ed B

org

Dys

pn

oea

Sca

le d

uri

ng

exe

rcis

e as

sess

men

t

Ass

ess

pat

ien

t’sg

oal

s

Pati

ents

sho

uld

be e

valu

ated

fo

r con

trai

ndic

atio

ns a

nd

prec

auti

ons

to e

xerc

ise.

Su

perv

isor

y st

aff s

houl

d be

aw

are

of th

e cr

iteri

a fo

r te

rmin

atio

n of

a te

st, a

nd

othe

r im

port

ant s

afet

y is

sues

.

Impl

emen

ting

the

Prog

ram

A p

rim

ary

goal

of p

ulm

onar

y re

habi

litat

ion

is to

redu

ce th

e pa

tien

t’s p

erce

ptio

n of

sh

ortn

ess

of b

reat

h.

Hel

ping

pat

ient

s to

iden

tify

th

eir m

ost s

alie

nt ‘p

robl

ems’

can

help

pat

ient

s to

es

tabl

ish

ach

ieva

ble

and

mot

ivat

ing

‘goa

ls’.

ST

EP

1 |

Pat

ien

t ass

essm

ent

ww

w.p

ulm

on

aryr

ehab

.co

m.a

u

Th

E P

ULM

ON

ARY

REh

ABIL

ITATIO

N T

OO

LkIT

is

an o

n-l

ine

toolk

it

pro

vidin

g a

ll to

ols

nec

essa

ry

to s

et u

p b

est-

pra

ctic

e

pulm

onar

y re

hab

ilita

tion.

Vis

it w

ww

.pulm

onar

yreh

ab.c

om

.au

PULM

ON

ARY R

Eh

ABIL

ITATIO

N

FACTSh

EET O

utlin

es t

he

ben

efits

of pulm

onar

y re

hab

ilita

tion for

pat

ients

rel

uct

ant

to e

xerc

ise.

LUN

GS I

N A

CTIO

N C

om

munity

bas

ed e

xerc

ise

pro

gra

m s

pec

ially

dev

eloped

for

those

with C

OPD

w

ho h

ave

com

ple

ted p

ulm

onar

y

rehab

ilita

tion a

nd w

ant

to c

ontinue

an e

xerc

ise

regi

me

in t

he

com

munity.

ThE L

UN

G A

GE E

STI

MATO

R h

as b

een

deve

loped t

o s

upport

clin

icia

ns

to

motiva

te c

urr

ent

smoke

rs t

o q

uit,

by p

rovi

ding

a gr

aphic

illu

stra

tion

of

estim

ated

lung

age.

It

is a

vaila

ble

on

Aust

ralia

n L

ung

Founda

tion

’s P

rim

ary

Car

e Res

pira

tory

Too

lkit w

hic

h c

an b

e fo

und

on t

he

Lung

Founda

tion

web

site

.

Th

e B

en

efi

ts o

f P

ulm

on

ary R

eh

ab

ilit

ati

on

W

hat

is p

ulm

on

ary r

eh

ab

ilit

ati

on

?

Pulm

onary

rehabilitation is a

com

pre

hensiv

e p

rogra

m f

or

people

liv

ing w

ith c

hro

nic

lung d

isease w

ho

have s

ym

pto

ms o

f bre

ath

lessness a

nd o

ften h

ave a

decre

ased a

bility t

o p

erf

orm

the a

ctivitie

s o

f daily

life

. P

rogra

ms a

re i

ndiv

idually t

ailore

d a

nd d

esig

ned t

o o

ptim

ise p

hysic

al

and s

ocia

l w

ellbein

g.

The

str

uctu

re a

nd d

elivery

of

each p

rogra

m is d

iffe

rent

and d

epends u

pon local re

sourc

es.

Wh

at

are t

he a

ims?

The a

ims o

f pulm

onary

rehabilitation a

re t

o:

•

Encoura

ge p

hysic

al fitn

ess

•

Impro

ve q

uality

of

life

•

Incre

ase p

art

icip

ant’s a

bility t

o c

ope w

ith t

he a

cute

and c

hro

nic

phases o

f chro

nic

lung d

isease

•

Reduce h

ospital adm

issio

ns a

nd length

of

sta

y o

n h

ospital

Wh

o a

tten

ds p

ulm

on

ary r

eh

ab

ilit

ati

on

?

In g

enera

l, p

ulm

onary

rehabilitation p

rogra

ms a

re s

uitable

for

people

who h

ave c

hro

nic

lung d

isease

and w

ho a

re lim

ited b

y b

reath

lessness.

Part

ners

or

care

giv

ers

are

als

o e

ncoura

ged t

o a

ttend.

Wh

at

do

es t

he p

ro

gram

co

nsis

t o

f?

The pro

gra

m consis

ts of

an in

div

idual

assessm

ent

follow

ed by exerc

ise tr

ain

ing and education.

Norm

ally you w

ill

att

end tw

ice a w

eek fo

r about

8 w

eeks.

At

the end of

the pro

gra

m,

there

is

norm

ally a

re-a

ssessm

ent

and b

y t

his

poin

t, t

here

will be a

n a

gre

ed p

lan in p

lace o

f how

you w

ill be

able

to m

ain

tain

the b

enefits

gain

ed d

uri

ng t

he p

rogra

m.

I f

ind

exercis

e r

eall

y h

ard

, w

hy w

ill

do

ing

mo

re h

elp

me?

Exerc

ise is

som

eth

ing m

any people

w

ith chro

nic

lu

ng dis

ease find re

ally difficult and oft

en,

people

who are

short

of

bre

ath

find activity hard

er

and hard

er

to do over

tim

e.

Exerc

ise tr

ain

ing is

an

essential

part

of

the pro

gra

m,

help

ing to

re

vers

e th

is “c

ycle

of

inactivity”.

C

linic

al

tria

ls have

consis

tently s

how

n t

hat

an i

mpro

vem

ent

in e

xerc

ise t

ole

rance i

s o

ne o

f th

e m

ain

benefits

follow

ing

com

ple

tion o

f pulm

onary

rehabilitation.

Th

e B

en

efi

ts o

f P

ulm

on

ary R

eh

ab

ilit

ati

on

W

hat

is p

ulm

on

ary r

eh

ab

ilit

ati

on

?

Pulm

onary

rehabilitation is a

com

pre

hensiv

e p

rogra

m f

or

people

liv

ing w

ith c

hro

nic

lung d

isease w

ho

have s

ym

pto

ms o

f bre

ath

lessness a

nd o

ften h

ave a

decre

ased a

bility t

o p

erf

orm

the a

ctivitie

s o

f daily

life

. P

rogra

ms a

re i

ndiv

idually t

ailore

d a

nd d

esig

ned t

o o

ptim

ise p

hysic

al

and s

ocia

l w

ellbein

g.

The

str

uctu

re a

nd d

elivery

of

each p

rogra

m is d

iffe

rent

and d

epends u

pon local re

sourc

es.

Wh

at

are t

he a

ims?

The a

ims o

f pulm

onary

rehabilitation a

re t

o:

•

Encoura

ge p

hysic

al fitn

ess

•

Impro

ve q

uality

of

life

•

Incre

ase p

art

icip

ant’s a

bility t

o c

ope w

ith t

he a

cute

and c

hro

nic

phases o

f chro

nic

lung d

isease

•

Reduce h

ospital adm

issio

ns a

nd length

of

sta

y o

n h

ospital

Wh

o a

tten

ds p

ulm

on

ary r

eh

ab

ilit

ati

on

?

In g

enera

l, p

ulm

onary

rehabilitation p

rogra

ms a

re s

uitable

for

people

who h

ave c

hro

nic

lung d

isease

and w

ho a

re lim

ited b

y b

reath

lessness.

Part

ners

or

care

giv

ers

are

als

o e

ncoura

ged t

o a

ttend.

Wh

at

do

es t

he p

ro

gram

co

nsis

t o

f?

The pro

gra

m consis

ts of

an in

div

idual

assessm

ent

follow

ed by exerc

ise tr

ain

ing and education.

Norm

ally you w

ill

att

end tw

ice a w

eek fo

r about

8 w

eeks.

At

the end of

the pro

gra

m,

there

is

norm

ally a

re-a

ssessm

ent

and b

y t

his

poin

t, t

here

will be a

n a

gre

ed p

lan in p

lace o

f how

you w

ill be

able

to m

ain

tain

the b

enefits

gain

ed d

uri

ng t

he p

rogra

m.

I f

ind

exercis

e r

eall

y h

ard

, w

hy w

ill

do

ing

mo

re h

elp

me?

Exerc

ise is

som

eth

ing m

any people

w

ith chro

nic

lu

ng dis

ease find re

ally difficult and oft

en,

people

who are

short

of

bre

ath

find activity hard

er

and hard

er

to do over

tim

e.

Exerc

ise tr

ain

ing is

an

essential

part

of

the pro

gra

m,

help

ing to

re

vers

e th

is “c

ycle

of

inactivity”.

C

linic

al

tria

ls have

consis

tently s

how

n t

hat

an i

mpro

vem

ent

in e

xerc

ise t

ole

rance i

s o

ne o

f th

e m

ain

benefits

follow

ing

com

ple

tion o

f pulm

onary

rehabilitation.

Co

Pd

reso

urc

es