Respiratory disease best practice
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This document discusses best practices for treating chronic respiratory diseases like COPD. It covers assessing patients' pulmonary function and health status, providing treatment and education, and preventing disease progression and exacerbations. Key recommendations include using spirometry to diagnose and monitor COPD, prescribing bronchodilators and steroids for stable COPD, and referring patients to pulmonary rehabilitation. The goals are to optimize patients' lung function and quality of life through evidence-based clinical management and self-care.
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Respiratory disease best practice
- 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 •
- 14. 2. Treatment & Intervention • • : tracheostomy-related care, chest physical therapy, breathing exercise • ( (ADL, sleep • : , living arrangements, • 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
- 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 • :
- 35. Other evidences …. • COPD • •
- 36. Questions are welcome Gracias ! The Australian Lung