BPOC in Medicina Primara
BPOC in Medicina Primara
BPOC in Medicina Primara
PREVENTION OF EXACERBATIONS
NON-PHARMACOLOGICAL TREATMENTS3
Smoking cessation Even after diagnosis, stopping smoking will have a significantly positive impact on patients health and disease progression Encouraging smoking cessation will help improve cough and sputum, and slow disease progression (cessation may lead to a temporary increase in cough and sputum) Activity Many people with COPD are frightened to take daily activity for fear that being breathless may harm them and as a result patients can become unfit, tired and even more breathless Exercise is important in keeping the lungs healthy and feeling breathless is a natural consequence of physical exercise Encourage all patients to take or continue daily activity to help prevent deconditioning Pulmonary rehabilitation This is an individually tailored programme comprising exercise, education, emotional support and optimising treatment. Pulmonary rehabilitation is designed to improve an individuals physical/mental well-being and autonomy Pulmonary rehabilitation should be available to all patients who could benefit from it
Protocol
IF YES TO ANY
IF NO
PHARMACOLOGICAL TREATMENTS3
Optimising pharmacological therapy may help reduce the frequency of exacerbations. Optimise bronchodilator therapy with one or more long-acting bronchodilator (2 agonist or anticholinergic) For patients on short-acting bronchodilators with persistent symptoms, to reduce the frequency of exacerbations. Add inhaled corticosteroids (usually in combination with long-acting bronchodilators) For patients suffering more than two exacerbations a year and FEV1<50% predicted, to reduce exacerbation frequency and rate of decline in health status. Mucolytic therapy For consideration in patients with a chronic cough productive of sputum. Should be continued if there is symptomatic improvement (for example, reduction in frequency of cough and sputum production).
IF YES TO MOST
IF NO TO MOST
FREQUENCY OF EXACERBATIONS
Exacerbations are frequent among patients with COPD at any stage, even those with an FEV1 of 50% predicted10. The majority of patients report two or more exacerbations a year, regardless of lung function10.
Contributors
Dr Antony Crockett GP, Shrivenham, Wiltshire Dr Lisa Davies Consultant Chest Physician University Hospital Aintree, Liverpool Dr Rupert Jones MRCGP, GP, Plymouth Clinical Research Fellow, Peninsula Medical School, Plymouth Professor David Price GPIAG Professor of Primary Care Respiratory Medicine, Dept of General Practice and Primary Care, University of Aberdeen Jane Scullion Respiratory Nurse Consultant, Leicester Chair of the Respiratory Nurses Forum Dr Mike Thomas Asthma UK Research Fellow, Dept of General Practice, University of Aberdeen GP, Minchinhampton, Gloucestershire Hospital Practitioner Respiratory Medicine, Stroud Hospital
To request further copies of The treatment and prevention of exacerbations in COPD: the role of primary care guide, please call the information and publications line 020 7688 5555
References
1
National Respiratory Training Centre. Impact of Respiratory Conditions: a guide for Primary Care Organisations. Warwick: NRTC (2002). National Asthma and Respiratory Training Centre. Respiratory conditions: are health needs being met? Warwick: NARTC (2000). National Collaborating Centre for Chronic Conditions. Chronic Obstructive Pulmonary Disease: National clinical guideline on management of adults with chronic obstructive pulmonary disease in primary and secondary care. NICE guideline 12. Thorax 2004;59 (Suppl I): 1-232. Donaldson GC, Seemungal TAR, Bhowmik A, Wedzicha JA. Relationship between exacerbation frequency and lung function decline in chronic obstructive pulmonary disease. Thorax 2002;57: 847-852.
British Lung Foundation 73-75 Goswell Road London EC1V 7ER T: 020 7688 5555 E: enquiries@blf-uk.org www.lunguk.org registered charity no: 326730 Helpline number: 08458 50 50 20 Monday to Friday 10am 6pm
Kanner RE, Anthonisen NR, Connett JE. Lower respiratory illness promote FEV1 decline in current smokers but not ex smokers with mild chronic obstructive pulmonary disease. Results from Lung Health Study. Am J Respir Crit Care Med 2001;164: 358-364. Seemungal TAR, Donaldson GC, Bhowmik A, Wedzicha JA. Frequent COPD exacerbators show accelerated decline in lung function. Am J Respir Crit Care Med 2001;163(5): A772. Seemungal TAR, Donaldson GC, Bhowmik A, Wedzicha JA. Frequent COPD exacerbators have more severe exacerbations. Am J Respir Crit Care Med 2001;163(5): A769.
Seemungal TAR, Donaldson GC, Paul EA, Bestall JC, Jeffries DJ, Wedzicha JA. Effect of exacerbation on quality of life in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1998;157: 1418-1422. Pauwels RA, Buist AS, Calverley PMA, Jenkins CR, Hurd SS. Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2001;163: 1256-1276. OReilly JF, Williams AE, Rice L, Holt K. Incidence and impact of healthcare-defined exacerbation amongst a cohort of primary care COPD patients. Presented at European Respiratory Society Annual Congress, 4-8 September 2004, Glasgow, UK.
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11
Seemungal TAR, Donaldson GC, Bhowmik A, Jeffries DJ, Wedzicha JA. Time course and recovery of exacerbations in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2000;161: 1608-1613.
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