BREATHE
Case 1: Mr PB - Optimise COPD management
Optimising function:
Assessment is the first step to optimising function
•Mr PB has a few good days a week, but does cough up sputum on most days
•Not breathless at rest but has breathlessness with activity on most days and usually wakes up
with chest tightness or wheeze
•Breathless on bending over and can only walk up a flight of stairs slowly
•Independent with housework, slowly and pacing with rests
•Current smoker – approx. 50PY, 20 - 25 cigs/day, occasional vaping
•Relevant investigation findings - Mild hyperinflation on CXR; No arrhythmia; Bloods – NAD
Consider non-pharmacological strategies
Optimise pharmacotherapy using a stepwise approach
•LAMA inhaled therapy initiated
Optimise treatment of co-morbidities
•IHD review with cardiologist scheduled/medication regimen and compliance confirmed
When should referral to specialist respiratory services be made?
dherence: Check medication use & technique
Recommendations for all patients:
Check:
•Adherence with pharmacological treatment strategies
•Inhaler technique, especially in older, frail and cognitively impaired patients
•Consider a home medicines review by a consultant pharmacist
Resources:
•Videos of correct inhaler technique and factsheets for a range of devices available:
•https://lungfoundation.com.au/support-and-resources/living-with-a-lung-disease/using-your-inhaler/
•https://www.nationalasthma.org.au/how-to-videos
•https://asthma.org.au/devices-techniques/
•Information about inhaler devices is available on the NPS Medicinewise & NAC websites
•https://www.nps.org.au/consumers/inhaler-devices-for-respiratory-medicines
•https://files.nationalasthma.org.au/resources/Inhaler-technique-checklist_NPS-Medicinewise_2020.pdf
obacco: Discuss smoking cessation and supports
Ask-Advise-Help
•Ask all patients about smoking status and document this in their medical record
•Advise all patients who smoke to quit in a clear, non-confrontational and personalised way, and advise of the best way to quit
•Help by offering all patients who smoke an opt-out referral to behavioural intervention through Quitline (13 78 48), and by prescribing (or helping patients to access) pharmacotherapy
The Royal Australian College of General Practitioners. Supporting smoking cessation: A guide for health professionals. 2nd edn. East Melbourne, Vic: RACGP, 2019. (revised Sep 2021)
elp: Consider referral to specialist services
When should you ‘phone a friend’! Referral to specialist service.
COPD specialist referrals
•For severe disease consider referral to specialist services as needed e.g. long term oxygen therapy (LTOT) assessment, lung volume reduction surgery (LVRS), specialist respiratory nurse
•Promote physical activity and discuss and refer to Pulmonary Rehabilitation where appropriate
•Discuss and consider referral to palliative care service as appropriate
xercise: Consider Pulmonary rehabilitation to promote physical activity
Evidence-based
Known to reduce exacerbation frequency and hospitalisation
Reverses the cycle of inactivity and assists with strategies for energy conservation
Provides valuable self-management and symptoms management education
Lung Foundation Australia Pulmonary Rehabilitation service finder: https://lungfoundation.com.au/services/?service_type=440