2. Personal
Attributes
Human Health &
Behaviors
Environments
Reciprocal causation

3. :
Ecological view
Societal / Public policy
Organizational / Community
Interpersonal
social supports &
networks, peer norms
Individual

5. •
•
•
•
•
•
•
•
•
• total health care
cost
•

6. Airway
diseases
Restrictive
conditions
Neuromusc
ular
disorders
Other
• Asthma
• Bronchiectasis
• Bronchiolitis
obliterans
• Chronic
bronchitis
• COPD****
• Cystic fibrosis
• Emphysema
• Asbestosis
• Chest wall
anomalies
• Interstitial
pulmonary
fibrosis
• Kyphoscoliosis
•
Pneumoconiosi
s
• Post-ARDS
• Recurrent
• Muscular
dystrophy
• Postpolio
syndrome
• Spinal cord
injury
• Spinal
muscular
atrophy
• MG
• Central
hypoventilation
syndromes
• Lung cancer
• Lung
transplantation
•
Nontuberculosis
mycobacterial
infection
• Pneumonia***
• Post-ATS, 2005

7. HHC
•
•
• OPD
• FEV1 30% predicted
•
cardiopulmonary status
•
•
•
Turner et al. (1994), Narsavage & Naylor (2000), Hansen-Flaschen (2004), American Thoracic Society (2005)

8. Home health care
Hands-on technical skills
•
•
•
•
•
•
•
•
•

9. 1. Assessment :
2.
Treatment/Intervention :
3. Patient/family
education :
Best practice
ATS (2005)

10. 1. Assessment :
•
• (pack-
years)
•
•
•
• Cognitive
•
•
•
•
•

11. 1. Assessment :
•
:
• pulse oximetry
ADL,
• PEFR (Peak expiratory
flow rate –

12. 1. Assessment :
• :
adherence,
• :
• :
• :
• Tracheostomy care• Structural barriers
•

13. 1. Assessment :
•
•
•
•
•
•
•
•
•
•
•
•

14. 2. Treatment &
Intervention
•
• :
tracheostomy-related
care, chest
physical
therapy, breathing
exercise
• (
(ADL, sleep
• :
, living
arrangements,
•
ADL, iADL
•

15. •
•
•
•
•
•
•
•
•
•
•
•
ADL, iADL
•
•

16. Best practice in COPD care: COPD-X
The Australian Lung

17. COPD-X : Confirm diagnosis
The Australian Lung

18. COPD-X : Confirm diagnosis
The Australian Lung

20. COPD-X : Optimize function
• 30 3-6
wk 10
3
•
The Australian Lung

22. COPD-X : Prevent deterioration
The Australian Lung

23. COPD-X : Develop self-management plan
The Australian Lung

24. COPD-X : Develop self-management plan

25. COPD-X : Manage eXeacerbation
The Australian Lung

26. The Australian Lung

27. Managing stable
COPD• Recommendation 1
dyspnea spirometry testing airflow
obstruction (Grade:
strong recommendation, moderate-quality
evidence.)
• Recommendation 2
FEV1 <60% predicted (strong
recommendation) inhaled bronchodilators &
oral glucocorticosteroids antibiotics
COPD exacerbations (GOLD Evidence A)
• Recommendation 3
Gianakos & Kaczynski, 2008

28. COPD Medications
Short-acting
beta2 agonists
Long-acting beta2
agonists
long-acting
inhaled
anticholinergics
generic name
(Trade Name)
• salbutamol
(albuterol, Ventolin)
• levosalbutamol
(levalbuterol,
Xopenex)
• terbutaline (Bricanyl)
• pirbuterol (Maxair)
• procaterol
• metaproterenol
• salmeterol (Serevent
Diskus)
• formoterol (Foradil,
Symbicort)
• bambuterol
• clenbuterol
intracellular
calcium,
membrane potassium
conductance,
Tiotropium (Spiriva)
mucus

29. COPD Medications
Abramson, Crocke
tt, Frith &
McDonald, 2006
(for Australian

30. Best practice in COPD care
• Recommendation 4
an FEV1 <60% predicted
(Grade: weak
recommendation, moderate-quality evidence.)
• Recommendation 5
oxygen therapy resting
hypoxemia (PaO2 ≤55 mm Hg). (Grade: strong
recommendation, moderate-quality evidence.)
• Recommendation 6
pulmonary rehabilitation COPD
FEV1 <50% predicted. (Grade: weak Gianakos & Kaczynski, 2008

31. Diet and Nutrition for
chronic respiratory disease (CDC)
• pulmonary function improvement
low salt diet
• marine fatty acids (fish oil)
•
• Obesity
• Obesity
COPD

32. Other evidences ….
• :
(adherence) ATS, 2005
• Non-adherence
(dementia, MMSE < 24),
• MDI non-adherence

33. Other evidences ….
•
• (S. aureus)
• (P.
aeruginosa)
•
1:3) 60
• :

34. Other evidences ….
•
ADL
•
•

35. Other evidences ….
• COPD
•
•

36. Questions are welcome
Gracias !
The Australian Lung