Describe SABA use for COPD
- Improves sx, not exacerbations
- Schedule QID then PRN
- Only comes in MDI, so need an aerochamber
- AE = increased nervousness, increased HR, headache
Describe LAMA use for COPD
- Decreases exacerbations, hospitalizations, adverse effects, and increases QoL
- Schedule once or twice daily
- AE = dry mouth, cough, constipation
Describe LABA use for COPD
- Decreases sx
- Increases QoL and FEV1
- Schedule once or twice daily
- AE = increased HR; similar AEs to SABA, but less substantial
Describe COPD exacerbation management
- Exacerbation = acute worsening of sx over more than 48 h
1. Schedule salbutamol or ipratropium 2 puffs QID and continue maintenance inhalers
2. Systemic steroids (prednisone 50 mg x 5 days) -> increases FEV1 and decreases tx failure
3. Antibiotics if change in sputum colour and increased sputum volume or increased dyspnea
Drug interactions w/ COPD drugs
LABA –> 3A4 inhibitors may increase AE of salmeterol
Red flags for COPD
- Unresponsive to therapy
- Severe and recurrent exacerbations
- Too breathless to leave the house, or breathless when dressing or undressing (this would be severe or very severe COPD)
Specific questions to ask for COPD
- How are you using your inhaler?
- Can you show me how you take a puff?
- What are your main symptoms? Have they been getting worse over the past few days?
- Have you had a spirometry?
- Do you have asthma?
- Do you use an aerochamber? (for the MDIs)
Non-pharms for COPD
- Smoking cessation
- Vaccinations (annual flu and pneumonia)
- Physical activity
- CVD risk reduction when applicable
- Pulmonary rehab
General monitoring for COPD
- Monitor adherence and technique
- SABA and LABA will help w/ sx; LAMA will help w/ QoL
General follow-up for COPD
- 2 weeks after starting new inhaler to address technique
- Follow-up regarding smoking cessation (if needed)
Describe monitoring for COPD when adding a LAMA
- Monitor for side effects daily and sx improvement weekly
- Not really for sx improvement, more to prevent exacerbations
- Common SE = dry mouth (rinse mouth after inhalation to decrease this), cough, constipation, headache
Describe when to go to a Dr for COPD when adding a LAMA
If sx don’t improve within 4 weeks?
Describe when to go to emergency for COPD when adding a LAMA
Go to emergency if experiencing an exacerbation (shortness of breath at rest, increased sputum production, change in sputum colour, etc.)
Describe non pharms for COPD when adding a LAMA
- Pulmonary rehab
- Smoking cessation
- Vaccinations (flu shot and pneumococcal)
- Avoid triggers (if possible)
- Physical activity
Describe follow up for COPD when adding a LAMA
- I will follow up with you 1 week to discuss sx improvement, side effects, and adherence
- Also follow up regarding smoking cessation (if applicable)
Describe monitoring for COPD when adding a LABA
- Monitor for sx improvement and side effects daily/weekly
- Used for sx
- Common SE = tremors, increased HR
Describe when to go to a Dr for COPD when adding a LABA
Go to doctor if you find that your sx aren’t improving or are getting slightly worse after 4 weeks?
Describe when to go to emergency for COPD when adding a LABA
Go to emergency if signs and sx of an exacerbation
Describe non pharms for COPD when adding a LABA
- Pulmonary rehab
- Smoking cessation
- Vaccinations (flu shot and pneumococcal)
- Avoid triggers (if possible)
- Physical activity
Describe follow up for COPD when adding a LABA
- I will follow up with you 1 week to discuss sx improvement, adherence, and side effect management
- Also follow up regarding smoking cessation (if possible)
Describe monitoring for COPD after an exacerbation
- Monitor for exacerbation sx improvement daily
- Continue to monitor other COPD sx daily/weekly
Describe when to go to a Dr for COPD after an exacerbation
Go to doctor if sx haven’t improved at all after full course of prednisone (+/- antibiotic) has been properly completed, or if sx have improved slightly but not fully after 3-5 days of completing the regimen
Describe when to go to emergency for COPD after an exacerbation
Go to emergency if sx worsen or you have an allergic reaction to prednisone/antibiotic
Describe non pharms for COPD after an exacerbation
- Pulmonary rehab
- Smoking cessation
- Vaccinations (flu shot and pneumococcal)
- Avoid triggers (if possible)
- Physical activity
