managing copd nephron pharmaceuticals corporation sponsored by masters 14 august 2010
TRANSCRIPT
Managing COPD
Nephron Pharmaceuticals Corporation
Sponsored by Masters
14 August 2010
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Presenter details
Michael McGowanRegional manager and Director of International Sales and [email protected]
Marie MoranTerritory Manager, nationwide and International [email protected]
www.nephronpharm.com www.masters-uk.com
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Overview
Understanding COPD and associated conditions
Causes and prevalence of COPD Treatment options Pharmacist’s role in managing
COPD Advocacy/patient groups
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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.
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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.
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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
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Umbrella of COPD
■ Chronic Bronchitis■ Emphysema
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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.
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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.
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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.
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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.
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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.
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Treatment options Current pharmacotherapies cannot
cure COPD Pharmacotherapies can help control
the condition- Bronchodilators (β-agonists & Anticholinergics)- Inhaled corticosteroids- Oxygen therapy
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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
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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)
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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
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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.
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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
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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
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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
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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
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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
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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
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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
Thank you!
Nephron Pharmaceuticals Corporation
Sponsored by Masters
14 August 2010