respiratory_recap_1_ (2) (2)

Page 1: Introduction

• Speaker: Joelle Ayoub, PharmD, BCACP, APh

• Title: Assistant Professor of Pharmacy Practice

• Institution: Western University of Health Sciences College of Pharmacy

Page 2: Differences between Asthma and COPD

• Asthma:

  • Young age of onset

  • Characterized by inflammation and bronchoconstriction of airways.

  • Inflammatory mediators activated: histamine, IgE, mast cells.

  • Symptoms are reversible and typically do not worsen over time.

  • First-line treatment: Inhaled Corticosteroids (ICS).

  • Triggers: Various allergenic and non-allergenic triggers.

• COPD:

  • Usually develops after age 40.

  • Characterized by obstructed airflow caused primarily by pollutants and tobacco smoke.

  • Comprises bronchitis (inflammation/narrowing of bronchial tubes) and emphysema (destruction of alveoli).

  • Symptoms are not fully reversible.

  • First-line treatment: Bronchodilators.

Page 3: Treatment Guidelines

• Asthma: Follow GINA (Global Initiative for Asthma) guidelines.

• COPD: Follow GOLD (Global Initiative for Chronic Obstructive Lung Disease) guidelines.

• Inhalers: Familiarize with various inhalers and their respective treatments.

Page 4: Spirometry Basics

• Spirometry Measurements:

  • FEV1: Forced expiratory volume in one second.

  • FVC: Forced vital capacity.

  • PEF: Peak expiratory flow, measured in liters per minute.

• Recommendations: Yearly spirometric studies as per NAEPP (National Asthma Education and Prevention Program).

• Common Observations:

  • Decrease in FEV1 and FVC indicates worsening flow limitation.

  • FEV1/FVC ratio <0.7 suggests obstructive lung disease.

Page 5: Types of Inhalers

• Metered Dose Inhalers (MDI) with Spacer

• Various DPI (Dry Powder Inhalers):

  • Diskus, Handihaler, Twisthaler, Flexhaler, Respimat, Pressair, Aerolizer, Neohaler, Turbuhaler, Ellipta.

Page 6: Common Practicum Medications

• Albuterol: 1-2 puffs every 4-6 hours as needed for shortness of breath (SOB).

• Pulmicort Flexhaler: 2 puffs twice daily (BID).

• Advair Diskus: 1 puff BID (250/50).

• Spiriva: 1 capsule inhaled daily.

• Qvar: 2 puffs BID (with Aerochamber).

• Peak flow meter usage and zone identification system discussed.

Page 7: Aerosol Generation - MDI

• MDI Explanation:

  • Energy from the device.

  • Slow inhalation is crucial for effective medication delivery.

  • Spacers can enhance delivery but require dexterity.

  • May cause irritation due to propellants used.

Page 8: Aerosol Generation - DPI

• DPI Explanation:

  • Energy generated by the patient; requires fast, deep, forceful inhalation.

  • Cannot be used with spacers; requires coordination.

  • May cause throat irritation and coughing.

Page 9: Aerosol Generation - SMI

• Soft Mist Inhalers (Respimats):

  • Coiled spring mechanism requiring low inspiratory effort.

  • Mist is released slowly, minimizing need for coordination.

  • Less irritation in the throat with effective lung delivery.

Page 10: Triple Therapy Inhalers

• Triple Therapy for COPD:

  • Composed of a combination of medications tailored to individual patient needs.

Page 11: Beta Agonists

• Short-Acting Beta Agonists (SABAs): Albuterol (e.g., Proventil, Proair, Ventolin).

• Long-Acting Beta Agonists (LABAs): Salmeterol, Olodaterol, combined therapies (e.g., Stiolto Respimat).

• Combination products which include both ICS and LABA therapy.

Page 12: Inhaled Corticosteroids (ICS)

• ICS Examples:

  • Fluticasone formulations (e.g., Flovent, Advair) and other specific inhalers noted.

  • Emphasized use for persistent asthma management.

Page 13: Muscarinic Antagonists

• SAMA and LAMA medications:

  • Ipratropium (SAMA), Tiotropium (LAMA) for asthma and COPD management.

• Dosing guidelines specified for various formulations.

Pages 14-20: Pharmacological Overview

• Comprehensive listing and descriptions of medications including SABA, LAMA, and combinations across various delivery methods.

Page 21-22: Practice Questions

• Question 1: Identifying inhaler types from descriptions.

• Question 2: Correct usage and features of Advair Diskus.

• Question 3: Identification of DPI inhalers.

Pages 23-29: Asthma Recap

• Chronic Inflammatory Disorder:

  • Involves multiple cell types.

  • Symptoms include cough, wheezing, and breathlessness, often reversible.

• Asthma Triggers: Identified diverse range of potential triggers including allergens and environmental factors.

Page 30-32: Peak Flow Meter

• Usage Instructions:

  • Method of measuring peak expiratory flow rate (PEFR) and understanding zone categorization (green, yellow, red).

Pages 33-36: Asthma Symptoms and Management Strategy

• Emphasizes initial asthma symptoms and stages of pharmacologic therapy based on severity.

• Best Practices: Outlined approach for managing asthma exacerbations, including the use of peak flow meters.

Pages 37-39: Children’s Asthma Management

• Age-specific approach for assessing and adjusting asthma treatment plans for children under 5 and other age ranges.

Page 40-41: Adult Asthma Treatment

• Guidelines for initiating asthma treatment based on symptom frequency and severity.

Pages 42-43: Track 1 and Track 2

• Treatment progression for asthma patients enabling informed clinical decisions based on symptom patterns and response to therapies.

Page 44-45: SMART Therapy Inhalers

• Inhaler Options: Combination medications utilizing ICS and beta agonist providing proactive management of asthma symptoms.

Pages 46-52: Practice Questions

• Series of practice questions testing critical thinking and understanding of pharmacological therapy in asthma management.

Pages 53-71: COPD Overview and Management

• Detailed descriptions of COPD conditions (chronic bronchitis and emphysema), pharmacotherapeutic options, emergency management strategies, including systemic corticosteroid use.

Page 72-73: Practice Questions - COPD

• Tips for counseling patients on medication usage and assessments for COPD management with a focus on immunizations, inhalation technique, and medication adherence.

Page 74-76: Drug Counseling Best Practices

• Key considerations when counseling patients on inhalers and medications: importance of rinse, adherence monitoring, potential side effects, and patient education strategies.

Page 77: Summary of Key Points

• Asthma Recap: ICS-based therapy focused on allergen exposure.

• COPD Recap: LAMA/LABA therapy principles and adherence importance across treatment strategies.