managing copd

Managing COPD

Nephron Pharmaceuticals Corporation

Sponsored by Masters14 August 2010

nephron pharmaceuticals corporation

Sponsored by Masters 2

Presenter details Michael McGowan

Regional manager and Director of International Sales and [email protected]

Marie MoranTerritory Manager, nationwide and International [email protected]

www.nephronpharm.com www.masters-uk.com

http://www.nephronpharm.com/

http://www.masters-uk.com/



Overview Understanding COPD and

associated conditions Causes and prevalence of COPD Treatment options Pharmacist’s role in managing

COPD Advocacy/patient groups



What is COPD? COPD - Chronic Obstructive

Pulmonary Disease is a progressive lung disease.

Airways become narrower, resulting in difficulties with breathing.

Symptoms are treatable but the condition is irreversible and progressively worsens over time, unlike asthma where symptoms come and go.



Causes of COPD Most cases of COPD are caused by long-term exposure

to lung irritants that damage the lungs and airways, i.e. chemical fumes and organic dust such as grain, cotton, wood, or mining dust.

However, in the US the most common irritant is cigarette smoke.

In most patients, symptoms begin to show after the age of 40 years.

On rare occasions, a genetic condition called alpha-1 antitrypsin may play a role in development of COPD. Patients have low levels of alpha-1 antitrypsin (AAT) — a protein made in the liver.



Warning symptoms■ An annual increase/decrease in the amount of

sputum (phlegm) ■ A change in the color of the sputum to brown,

yellow or green■ The presence of blood in the sputum■ An unusual increase in the severity of

breathlessness■ Swelling in the ankles■ Unusual increase or decrease in weight■ Need to increase the number of pillows to sleep

comfortably■ Increasing lack of energy and tiredness



Umbrella of COPD

■ Chronic Bronchitis■ Emphysema



Chronic bronchitis Chronic bronchitis is an inflammation

of the bronchi. Clinically defined as a persistent

cough that produces sputum and mucus for at least three months in two consecutive years.

Tobacco smoke is the main cause.



Emphysema Characterized by damage to the

alveoli. Consequently, the body does not get

the oxygen it needs, making it hard to catch breath, development of a persistent cough and trouble breathing during exercise.

Tobacco smoke is most common cause.



Prevalence of COPD The World Health Organization

estimates that 80 million people worldwide have moderate to chronic COPD.

In 2005, more than 3 million died of COPD, equating to 5% of all deaths globally.

Almost 90% of COPD deaths occur in low and middle-income countries.



COPD rates rising In the US, COPD is the 4th leading

cause of death. Estimated to become 3rd leading cause of death worldwide by 2030.

Affects men and women equally, owing to increased tobacco use among women in higher-income countries and greater exposure to indoor air pollution (biomass fuel) in low-income countries.



Economic burden In 2007, the US spent $42.6 billion on

COPD healthcare costs and loss of productivity.

About 24 million Americans have COPD, according to the American Lung Association. However, only about half have been diagnosed with the condition.



Treatment options Current pharmacotherapies cannot

cure COPD Pharmacotherapies can help control

the condition- Bronchodilators (β-agonists & Anticholinergics)- Inhaled corticosteroids- Oxygen therapy



Bronchodilators■ Bronchodilators open the airways and

are an important part of COPD pharmacotherapy.

■ Bronchodilators relax the smooth muscles that line the walls of the breathing tubes, making the airway wider and easier for air to move through.

■ Can be administered as tablets, liquids, or inhalation



Bronchodilator classes Two main classes of Bronchodilators:

Beta- Agonists and Anticholinergics

■ Beta- Agonists□ Relax the muscles surrounding the

airways□ Two types: short-acting and long-acting

beta agonists (SABAs and LABAs)



SABAs SABAs – Short-acting β agonist Example of SABA = Albuterol (a rescue remedy in

breathlessness) First beta receptor agonist to be marketed Usually administered through a nebulizer, but can

be given orally as an inhalant or intravenously Onset of action within 5 minutes Provides relief for up to 6 hours Common side-effects: palpitations, chest pain,

rapid heart rate, tremors or nervousness



LABAs LABAs – long Acting β agonist) Example of LABAs = Salmeterol and

Formoterol Physical effects are similar to SABAs

but effects can last up to 12 hours FDA has given LABAs a black box

warning following concerns that they can increase severity of asthma exacerbations and even risk of fatal asthma.



Alpha and beta receptor Drug that has a dual affinity for alpha and beta

receptors = Racepinephrine Racemic mixture of the enantiomorphs of

epinephrine Stimulates alpha properties, acting as a

vasoconstrictor to help reduce mucosal and submucosal oedema

Also stimulates Beta properties that act as bronchodilators, resulting in the enlargement of airways and facilitating secretion removal

Administered via inhalation as nebuliser therapy Onset of pharmacological action is immediate



Anticholinergics Blocks the chemical produced by our bodies that

normally causes the airway to contract Decreases mucous secretions Combined with Albuterol or Metaproterenol for

management of COPD. More effective than beta agonist alone.

Example = Ipratropium Bromide Usually administered by inhalation Onset within 15 minutes, therefore not

recommended for emergency use Half-life of about 6 hours



Corticosteroids For moderate to severe COPD that cannot be

controlled by conventional pharmacotherapy Do not prevent lung decline over time, but can

help reduce symptoms and reduce frequency of flare-ups

Drug is delivered by inhalation to the lungs, therefore usually fewer side-effects than oral treatment

However, high doses can affect other parts of the body and worsen conditions such as osteoporosis

Examples of Inhalation products = Budesonide, Fluticasone, Triamcinolone, Flunisolide, Beclomethasone



Oxygen therapy For severe COPD and low levels of oxygen in the

blood stream Supplemental oxygen can:

- improve sleep and mood- increase mental alertness and stamina- allow the body to carry out normal functions- prevent heart failure in people with severe lung disease

However, high doses for prolonged period can be toxic

Surgery may be considered as a last resort



Pharmacist’s role in managing COPD

Pharmacists play a crucial role in helping to prevent and manage COPD:- diagnosis- providing accurate and up-to-date information on COPD- encouraging healthier lifestyle, i.e. smoking cessation options, diet, exercise- Helping with compliance of prescribed medication and help improve the technique when using inhaled medication- Annual immunization against influenza. Influenza can lead to exacerbations and respiratory failure.

- Pharmacists can form support teams with other healthcare professionals



Useful links http://www.aarc.org – American Association of Respiratory Care http://emphysemafoundation.org – Emphysema Foundation http://www.nlm.nih.gov – Medline http://www.nhlbi.nih.gov/health/public/lung/copd/index.htm – National Hear

t and Lung Institute of US http://www.alpha1.org – Alpha1 National Association http://www.nlhep.org – National Lung Foundation USA http://www.breathingbetterlivingwell.com – patient support material http://www.olivija.com/SmokeNoMore http://www.copdadvocate.com – patient support http://www.phrma.org - listing of free medication http://www.thekitchenlink.com – for people with special dietary

requirements

http://www.copdadvocate.com/










http://www.phrma.org/

http://www.thekitchenlink.com/



More information This is a snapshot of managing COPD, but

we would be delighted to send you more detailed information

Contact Mike at [email protected] or Marie at [email protected]

www.nephronpharm.com www.masters-uk.com

http://www.nephronpharm.com/

http://www.masters-uk.com/

Thank you!

Nephron Pharmaceuticals Corporation

Sponsored by Masters14 August 2010

managing copd

Documents

chronic copd

development of copd

copd deaths

common cause

leading cause of death

tobacco smoke

main cause

cigarette smoke