Edward Omron MD, MPH, FCCPPulmonary, Critical Care, andInternal Medicine18525 Sutter Blvd, Suite 180Morgan Hill, CA 950371...
 Chronic, progressive shortness breath Symptoms◦ Cough◦ Phlegm◦ Chest Pressure◦ Wheezing◦ Exercise limitation
 Two irreversible lung diseases that frequentlycoexist together:◦ Chronic bronchitis: airways of the lung are inflamed,sw...
Bronchitic Emphysematous
 Third leading cause of death in America◦ 125,000 lives in 2007 Smoking is the primary risk factor for COPD Female smok...
 Tobacco Smoke!!!! Occupational Exposures◦ Coal Miners◦ Smelters◦ Shipyards Genetics is Very Important!
 Pulmonary Physician Appropriate Symptoms Diagnostic Studies◦ Chest X-Ray◦ Pulmonary Function Study◦ 6 minute walk test...
 Congestive Heart Failure Asthma Bronchiectasis Interstitial Lung Disease
 Patient Education◦ Early treatment for exacerbations◦ Appropriate treatment for symptoms◦ Reduce risk factors◦ How to tr...
 Bronchodilators◦ B Agonists◦ Anticholinergics◦ Xanthines Pulmonary Specialist to determine whichis best
 Glucocorticoids (Steroids)◦ Oral prednisone for flair-up of disease◦ Intravenous usage in hospital◦ Inhaled usage for ou...
 Vaccines◦ Influenza, pneumococcus Antibiotics Flutter valve Supplemental Oxygen Mucolytics Pulmonary Rehab
 Shortness of breath = inactivity Muscle Weakness = Fatigue Loss of independence = depression Isolation Weight Gain ...
 Builds Strength Less shortness of breath More independence Greater reserve to fight infection Less fatigue Weight c...
 Under care of a health professional Physical Therapist guides training Stretches Aerobic Conditioning How to cough, ...
 Indacaterol (Arcapta Neohaler)◦ Once daily long acting (24 hours) bronchodilator inCOPD◦ Rapid onset with intense bronch...
 Phosphodiesterase inhibitors (similar tocaffeine) Decreases airway inflammation Not a bronchodilator Side effects: He...
 A genetic condition associated with early onsetCOPD and liver disease Alpha 1-Antitrypsin is a enzyme that protects the...
 Inhaled long-term, once-daily maintenance treatment inpatients with chronic obstructive pulmonary disease(COPD) Combina...
 Lung Reduction Surgery◦ Improved exercise capacity, quality of life◦ Upper lobe emphysema best outcome◦ No survival adva...
 Stem cells are derived from the bone marrow◦ Can regenerate normal lung tissue with manipulation◦ Several studies in ani...
 American Lung Association◦ http://www.lung.org/lung-disease/ http://www.onebreath.org/ NEJM 2003; 348:2059-2073 NEJM ...
Edward M. Omron MD, MPH,FCCPPulmonary, Critical Care, and InternalMedicine 18525 Sutter Blvd, Suite 180 Morgan Hill, CA ...
New Therapies for COPD 2013 Edward Omron MD, MPH, FCCP
New Therapies for COPD 2013 Edward Omron MD, MPH, FCCP
New Therapies for COPD 2013 Edward Omron MD, MPH, FCCP
New Therapies for COPD 2013 Edward Omron MD, MPH, FCCP
New Therapies for COPD 2013 Edward Omron MD, MPH, FCCP
New Therapies for COPD 2013 Edward Omron MD, MPH, FCCP
New Therapies for COPD 2013 Edward Omron MD, MPH, FCCP
New Therapies for COPD 2013 Edward Omron MD, MPH, FCCP
New Therapies for COPD 2013 Edward Omron MD, MPH, FCCP
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New Therapies for COPD 2013 Edward Omron MD, MPH, FCCP

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A review of new therapies for COPD/emphysema for non-health care professionals. This presentation is intended for my pulmonary clinic patients

Edward Omron MD, MPH, FCCP
Pulmonary, Critical Care, and Internal Medicine
18525 Sutter Blvd, Suite 180
Morgan Hill, CA 95037
1-408-778-0022
www.docomron.com

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New Therapies for COPD 2013 Edward Omron MD, MPH, FCCP

  1. 1. Edward Omron MD, MPH, FCCPPulmonary, Critical Care, andInternal Medicine18525 Sutter Blvd, Suite 180Morgan Hill, CA 950371408-778-0022deepbreath@docomron.comwww.docomron.com
  2. 2.  Chronic, progressive shortness breath Symptoms◦ Cough◦ Phlegm◦ Chest Pressure◦ Wheezing◦ Exercise limitation
  3. 3.  Two irreversible lung diseases that frequentlycoexist together:◦ Chronic bronchitis: airways of the lung are inflamed,swollen and narrowed resulting in “wheezing” HEAVY mucus or phlegm is coughed up Breeding ground for recurrent infections◦ Emphysema: the scaffolding of the lung is destroyedresulting in multiple “holes”
  4. 4. Bronchitic Emphysematous
  5. 5.  Third leading cause of death in America◦ 125,000 lives in 2007 Smoking is the primary risk factor for COPD Female smokers are 13 times more likely to diefrom COPD than females who never smoked 13 million adults were estimated to have COPDin 2008 50 Billion in health care costs yearly
  6. 6.  Tobacco Smoke!!!! Occupational Exposures◦ Coal Miners◦ Smelters◦ Shipyards Genetics is Very Important!
  7. 7.  Pulmonary Physician Appropriate Symptoms Diagnostic Studies◦ Chest X-Ray◦ Pulmonary Function Study◦ 6 minute walk test◦ Arterial Blood Gas◦ Alpha 1 antitrypsin deficiency
  8. 8.  Congestive Heart Failure Asthma Bronchiectasis Interstitial Lung Disease
  9. 9.  Patient Education◦ Early treatment for exacerbations◦ Appropriate treatment for symptoms◦ Reduce risk factors◦ How to treat an exacerbation◦ Inhalers◦ Nebulizers◦ Pulmonary Rehabilitation
  10. 10.  Bronchodilators◦ B Agonists◦ Anticholinergics◦ Xanthines Pulmonary Specialist to determine whichis best
  11. 11.  Glucocorticoids (Steroids)◦ Oral prednisone for flair-up of disease◦ Intravenous usage in hospital◦ Inhaled usage for outpatient Risks◦ Fractures◦ Diabetes◦ Infection
  12. 12.  Vaccines◦ Influenza, pneumococcus Antibiotics Flutter valve Supplemental Oxygen Mucolytics Pulmonary Rehab
  13. 13.  Shortness of breath = inactivity Muscle Weakness = Fatigue Loss of independence = depression Isolation Weight Gain Immune system weakens
  14. 14.  Builds Strength Less shortness of breath More independence Greater reserve to fight infection Less fatigue Weight control Quality of life
  15. 15.  Under care of a health professional Physical Therapist guides training Stretches Aerobic Conditioning How to cough, breath, and train safely
  16. 16.  Indacaterol (Arcapta Neohaler)◦ Once daily long acting (24 hours) bronchodilator inCOPD◦ Rapid onset with intense bronchodilation◦ Improvement in shortness of breath, exerciseperformance, and quality of life.◦ Hopefully available later this year, excellent safetyprofile
  17. 17.  Phosphodiesterase inhibitors (similar tocaffeine) Decreases airway inflammation Not a bronchodilator Side effects: Headache, Nausea, Diarrhea Reduces COPD exacerbations Once daily oral dosing, cannot be used in liverdysfunction
  18. 18.  A genetic condition associated with early onsetCOPD and liver disease Alpha 1-Antitrypsin is a enzyme that protects thelung from enzymes that break down lung tissue About 1-3% of patients with COPD are predicted tohave alpha1-antitrypsin deficiency. Intravenous (IV) augmentation therapy with alpha1-antitrypsin benefits some patients Identified in all populations All COPD patients are now screened for thisdisorder
  19. 19.  Inhaled long-term, once-daily maintenance treatment inpatients with chronic obstructive pulmonary disease(COPD) Combination of the inhaled corticosteroid (ICS),fluticasone furoate and the long-acting beta2 agonist(LABA), vilanterol Will be available in the US during the third quarter of 2013 Should not be used as rescue therapy An increase in the incidence of pneumonia is noted withthis class of combination drugs
  20. 20.  Lung Reduction Surgery◦ Improved exercise capacity, quality of life◦ Upper lobe emphysema best outcome◦ No survival advantage Lung Transplantation◦ COPD, CF, IPF, Idiopathic PulmonaryHypertension◦ BODE Score 7-10◦ Median survival 6 years Endobrobronchial Valves◦ Advanced emphysema◦ Modest improvement
  21. 21.  Stem cells are derived from the bone marrow◦ Can regenerate normal lung tissue with manipulation◦ Several studies in animal models show great promisein COPD◦ Too early to comment Vitamin D◦ Early enthusiasm◦ Most recent study in severe COPD disappointing◦ No consensus
  22. 22.  American Lung Association◦ http://www.lung.org/lung-disease/ http://www.onebreath.org/ NEJM 2003; 348:2059-2073 NEJM 2010; 363: 1233-1244 Am J Respir Crit Care Med 2013; 187:468-475 Am J Respir Crit Care Med 2013; 187: 228-237 Am J Respir Crit Care Med 2011; 159-171
  23. 23. Edward M. Omron MD, MPH,FCCPPulmonary, Critical Care, and InternalMedicine 18525 Sutter Blvd, Suite 180 Morgan Hill, CA 95037 1-408-778-0022

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