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Part 2: Applying the COPD Treatment Guidelines for Better Care

July 11, 2018

As the third leading cause of death in the United States, symptoms from Chronic Obstructive Pulmonary Disease (COPD) negatively impact many of your residents’ daily life. COPD, which consists of multiple diseases including emphysema, chronic bronchitis and often asthma, affects breathing and airflow, making everything from routine activities to regular exercise a challenge. Following the correct COPD treatment is now more important than ever to address the disease and improve quality of life. 

Residents with COPD regularly suffer from breathing problems stemming from airflow blockages. These treatable symptoms are most often caused by smoking, but air pollutants, genetics, abnormal lung development and respiratory infections can also have an impact. To help prevent and treat COPD in your long-term care residents, use the GOLD guidelines to help create a care plan for your COPD patients. Following the COPD guidelines to determine the right treatment leads to better overall care for your residents.

The Goals of COPD Treatment

The COPD treatment guidelines aim to reduce frequency and severity of symptoms for your residents, while improving overall health and increasing exercise tolerance. In addition, lifestyle choices should be addressed alongside a pharmacological treatment plan. If still smoking, it is highly recommended that the resident stops smoking to help prevent symptoms. Up-to-date influenza and pneumococcal vaccines are also recommended. 

Finding a Pharmacological Treatment Plan

As with many treatment plans, every resident responds differently and requires customized interventions. It is important to evaluate a number of items while planning a successful care plan for each COPD patient. Before choosing a pharmacological treatment plan, examine:

  • Severity of symptoms
  • Risk of exacerbations
  • Drug side effects
  • Comorbidities (one or more additional diseases in the resident)
  • Drug availability and cost
  • Patient’s response to drugs

In addition, proper training on inhaler usage and technique is important for successful COPD treatment. Our HealthDirect team is happy to collaborate with you and your staff on an inhaler usage training program that addresses proper usage and best practices.  
 

Types of Pharmacological Treatment

After evaluating your resident’s COPD symptoms and overall health, understanding of the types of pharmacological treatment available can help LTC team members build a proper care plan. The COPD guidelines recommend bronchodilators to prevent and reduce COPD symptoms. Bronchodilators work by opening up the breathing passages by relaxing the bronchial smooth muscle. There are both short-acting and long-acting bronchodilators. 
Short-acting bronchodilators are used to stabilize COPD symptoms during a flare-up. They include Short-Acting Beta2Agonist (SABA) and Short-Acting Muscarinic Antagonist (SAMA). There are several SABA and SAMA medications available that can be taken regularly or as symptoms persist. 
 

Long-acting bronchodilators are used to control COPD symptoms, rather than provide a quick relief of symptoms.  LABA’s should never be used for as rescue medications. Like SABA and SAMA bronchodilators, they include Long-Acting Beta2Agonist (LABA) and Long-Acting Muscarinic Antagonists (LAMA). Generally, LAMA treatments are recommended over LABA treatments, as clinical trials have shown a greater effect on exacerbation rates for LAMA treatments. In addition, if combining short- and long-acting medications, it is not recommended to use SAMA with a LAMA. Use a SABA instead for better effectiveness and tolerability.

There are also combinations of SABA/SAMA and LABA/LAMA available to help both short- and long-term symptoms.

In residents with moderate to severe COPD, a LABA combined with an ICS is more effective than either alone in decreasing exasperations and improving lung function.

*It is important for residents to rinse mouth after each use of a steroid inhaler to prevent thrush from developing.

Use GOLD Guidelines to Find the Right Pharmacological Treatment

The GOLD Guidelines can help LTC professionals determine the best course of pharmacological treatment for residents. To find a treatment plan, use the COPD guidelines to determine the severity of the disease. (For help assessing COPD severity, review our guide on GOLD Guidelines implementation.)

After COPD assessment, LTC and other care professionals can use the COPD treatment guidelines below to find the best course of action. After a treatment plan is in place, it is important to regularly evaluate COPD symptoms to ensure the right medications are still being prescribed. The table below lays out next steps should the first line of treatment not be effective. 

 

Your Partner in COPD Treatment

From navigating the GOLD treatment guidelines to proper inhalation usage, HealthDirect is here to help your nursing care team implement COPD treatment guidelines. As your partner in COPD nursing management, we can train your team on emerging COPD treatments while providing knowledge on appropriate medication for your resident’s. Our pharmacy consultants look forward to working with you and your team on establishing COPD care protocol in your facility.

If you’re interested in learning more about how our pharmacy consultants can work with your team to develop a COPD nursing care plan, simply complete the form below. A member of our team will connect with you within 1 business day

 

 

Brandi VanValkenburg

Brandi provides personalized care as a pharmacy consultant with HealthDirect's northeastern region.  She's been serving our clients for nearly 10 years. 

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