RESPIRATORY
PhARmAcY mANAgEmENt of
RESPIRAtoRY coNdItIoNS
WIth oNE IN EIght EmERgENcY hoSPItAl AdmISSIoNS lINKEd to coPd PAtIENtS, PhARmAcY INtERvENtIoN cAN hElP to REdUcE A PAtIENt'S SYmPtomS ANd, coNSEqUENtlY, thE RISK of ExAcERBAtIoN. By chanel Jones
oBJEctIvES: 1. Be aware of classical symptoms and risk factors of coPd, Asthma and Pneumonia 2. Recap the pathology of coPd, Asthma and Pneumonia 3. Understand the evidence in support of current treatment and management, and how pharmacy can help patients understand their treatment.
INtRodUctIoN: Respiratory diseases are one of the world’s biggest health concerns, causing one sixth of all deaths
Table 1:
worldwide, with 600,000 respiratory related deaths in the European Union each year 1
. over half of these deaths
are due to lung cancer and chronic obstructive Pulmonary disease (coPd), and they are mainly caused by smoking 1
it will be the third leading cause of death worldwide 3
. one in eight
emergency hospital admissions are for coPd patients, making this the second largest cause of emergency admissions 4
. Respiratory illnesses are
the most common long-term conditions in children and babies with 21% of children having been diagnosed with asthma 2
. Respiratory
diseases cause disability and a premature death and are an economic burden, especially the ones that are preventable. coPd is the fourth leading cause of death worldwide, and the World health organization estimates that by 2030,
. this also makes it one of
the most expensive inpatient conditions treated by the NhS, as it is estimated to cost around £982 million each year 5
. table 1: table showing
the cost of various lung diseases to the European Union 1
ovERvIEW of thE coNdItIoNS chronic obstructive Pulmonary disease (coPd) is a progressive disorder, characterised by airflow limitation. this limitation is defined as a fEv1/fvc ratio <0.7. coPd is treatable, but not curable and unlike asthma and it is has little to no reversibility 6
. the cardinal symptoms
of coPd are: dyspnoea (shortness of breath), chronic cough and sputum production. coPd is caused by a combination of two conditions:
52 - PhARmAcY IN focUS
chronic bronchitis and emphysema (parenchymal damage). In chronic bronchitis, there is inflammation and fibrosis of the bronchial wall, which causes bronchoconstriction. there is also hypersecretion of mucus caused by the increase and hypertrophy of goblet cells. the combination of broncho-constriction and excess mucus leads to obstruction of airflow, thus causing the mismatch of ventilation and perfusion. Emphysema is caused by an inflammatory response which causes the breakdown of elastin in the alveolar wall, leading to loss of alveolar integrity as the alveoli are unable to recoil. loss of alveolar recoil decreases ventilation, thus causing air trapping. Air trapping is the cause of the barrel chest appearance in patients with emphysema because the air is still trapped in the lung.
Asthma is the most common respiratory condition, and it characterized by: airflow
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