Updated Asthma and COPD Guidelines Jonathan Douse Feb

Updated Asthma and COPD Guidelines Jonathan Douse Feb 2018 Our Passion, Your Care.

Asthma Guideline changes Our Passion, Your Care.

Why change? • BTS guidelines 2017 • New drugs / delivery devices Our Passion, Your Care.

What has changed? • Fostair Nexthaler replaces other dry powder devices Our Passion, Your Care.

Inhaler switches? • What to do about patients on seretide and symbicort? Our Passion, Your Care.

Inhaler switches? • What to do about patients on seretide and symbicort? • Consider switch at: – Annual review – Step up – Step down • If patient is desperate to stay on current inhaler? – Forcing change is unlikely to work Our Passion, Your Care.

COPD guideline changes Our Passion, Your Care.

Why change • New drugs • GOLD guidance • Old guidelines 2013 updated 2015 – Based on FEV 1 rather than symptoms – Patients tend to move towards triple therapy • Evidence of inhaled steroids increasing pneumonia risk Our Passion, Your Care.

Don’t worry! • We have tried to minimise changes – Inhalers will be familiar • Cost implications minimal Our Passion, Your Care.

Most important treatments for COPD • Smoking cessation • Flu vaccination • Pulmonary Rehabilitation Our Passion, Your Care.

Inhaler technique • There is no point in prescribing an inhaler if patient can’t use it! Our Passion, Your Care.

New Inhaler guidance • Reflects GOLD guidance • Based on symptoms and exacerbations • Need to know: – m. MRC score – CAT Our Passion, Your Care.

m. MRC Our Passion, Your Care.

COPD Assessment test • CAT Test – Available at www. catestonline. org. Our Passion, Your Care.

Our Passion, Your Care.

Gold A • • m. MRC: 0 -1 CAT: < 10 Exacerbations: 0 -1 Hospital admissions: 0 Our Passion, Your Care.

GOLD A Use any of the below and evaluate effect – after assessment either continue, stop or switch to alternative class from this list SABA Salbutamol MDI 100 mcg LABA Easyhaler Formoterol 12 mcg LAMA Seebri Breezhaler 44 mcg / Incruse Ellipta Our Passion, Your Care.

Gold B • • m. MRC: 2 or more CAT: 10 or more Exacerbations: 0 -1 Hospital admissions: 0 Our Passion, Your Care.

GOLD B Use any of the below and evaluate effect – after assessment either continue, stop or switch to alternative class from this list SABA LAMA Salbutamol MDI 100 mcg Seebri Breezhaler 44 mcg / Incruse Ellipta Easyhaler Formoterol 12 mcg LABA For persistent symptoms use: LAMA/LABA Anoro Ellipta 55/22 / Ultibro Breezhaler Our Passion, Your Care.

GOLD C • • m. MRC: 0 -1 CAT: <10 Exacerbations: 2 or more Hospital admissions: 1 or more Our Passion, Your Care.

Use any of the below and evaluate effect – after assessment either continue, stop or switch to alternative class from this list SABA Salbutamol MDI 100 mcg LAMA Seebri Breezhaler 44 mcg / Incruse Ellipta Further exacerbations, switch to: Anoro Ellipta 55/22 / Ultibro Breezhaler LAMA/LABA If further exacerbations or persistent symptoms consider switching inhaler to include ICS: please note: if control improves, step back down to LABA/LAMA) LABA/ICS Relvar Ellipta 92/22 [BDP 1000 mcg] or Fostair 100/6 [BDP 1000 mcg] Triple Combined inhaler – only to be used where the patient requires all three drugs to manage condition please note: if control improves, step back down to LABA/LAMA) LAMA/LABA/ICS Trelegy or Trimbow Our Passion, Your Care.

Gold D • • m. MRC: 2 or more CAT: 10 or more Exacerbations: 2 or more Hospital admissions: 1 or more Our Passion, Your Care.

Anoro Ellipta 55/22 / Ultibro Breezhaler If further exacerbations or persistent symptoms, consider switch to ICS containing regime below: (please note: if control improves, step back down to LABA/LAMA) Start with : LAMA/LABA/ICS Plus Relvar Ellipta 92/22 [BDP 1000 mcg] or Fostair 100/6 [BDP 1000 mcg] Seebri Breezhaler 44 mcg / Incruse Ellipta Triple Combined inhaler – only to be used where the patient requires all three drugs to manage condition please note: if control improves, step back down to LABA/LAMA) LAMA/LABA/ICS Trelegy or Trimbow Our Passion, Your Care.

Asthma and COPD overlap • Use combination LABA and ICS – Fostair 100/6 2 puffs twice daily (spacer) – Relvar 92/22 1 puff daily Our Passion, Your Care.

An advert • COPD team (shortlisted for IHT award) – Admission avoidance – Early supported discharge – Oxygen assessment • Pulmonary rehabilitation (recent national audit results) • National COPD audit results Our Passion, Your Care.

Do you remember? • My COPD Our Passion, Your Care.

Questions? Our Passion, Your Care.