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GP Practice Update

GP Practice Update. Lynn Orford Community Respiratory Team and HOSAR Lead. Spirometry. Guidelines published by the PCC in 2013 National recommendation for Diagnostic Spirometry to be quality assured come into effect 2020. Equipment. A spirometer that meets the correct industry standard

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GP Practice Update

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  1. GP Practice Update Lynn Orford Community Respiratory Team and HOSAR Lead

  2. Spirometry • Guidelines published by the PCC in 2013 • National recommendation for Diagnostic Spirometry to be quality assured come into effect 2020

  3. Equipment • A spirometer that meets the correct industry standard • One way mouthpieces and nose clips • Bacterial / viral filters • Height measure and weighing scales For reversibility testing • Nebuliser or single patient use volumatics • Short acting broncholdilator

  4. Calibration • Need a 3 litre syringe • This needs to be checked annually to ensure accuracy to within 15 ml • Calibrate before every session ( or 10 patients) • Document calibration/ verification

  5. Cleaning • Regular cleaning schedule • Document schedule • Need appropriate cleaning solution to the machine.

  6. Reasons for spirometry • Detect the presence of lung disease • Assist in diagnosis • Classify severity • Monitor deterioration of disease • To help guide optimal medication management

  7. Contra- indications to Spirometry • Active infection ( ideally to be 6 weeks post ) • Recent MI ( 6 weeks) • Aneurysm • Pneumothorax • Recent surgery ( 6 weeks) • Ophthalmic surgery • Communication/ability to follow instructions

  8. Infection control • Follow general infection control • Immune compromised patients ideally at beginning of session • Known infective patients should be at the end of the session and with a filter ( if not used routinely)

  9. The test • Is it acceptable ? • Is it repeatable ? • At least 3 forced manoeuvres – FEV1 & FVC • Graph should be smooth and free from irregularities • Exhalation – at least 6 seconds • VC, FVC– use the best one to calculate ratio • 2 best tests within 5% or 100 mL of each other

  10. Results • Numbers • Flow volume curve / loop • Volume/time curve

  11. Classifying Abnormal Function

  12. Problems as seen on volume / time curve

  13. Problems as seen on flow volume curve

  14. Normal

  15. Obstructive pattern • FEV1/FVC ratio less that 70% • Should also be below the lower limit of normal to help prevent false positive in the elderly and false negative in the younger age groups • FEV1 is used to measure the severity of obstruction

  16. Obstruction

  17. Restrictive Pattern • Normal or increased FEV1/FVC ratio • Low FVC • Need full lung function to determine cause • Easy to get false positive due to lack of patient cooperation or early termination leading to a falsely low FVC

  18. Restriction

  19. Different curves

  20. Mixed pattern • Restrictive and obstructive patterns occur together • FVC and FEV1/FVC ratio below the lower limit of normal • Need full lung function e.g. Total lung capacity and gas transfer

  21. Mixed Pattern

  22. South East London Guideline

  23. Relievers- short acting • Short acting • First line • Examples are • Ventolin, Salbutamol, • Bricanyl, Terbutaline • Atrovent, Ipratropium bromide • Typically previously mostly came in MDI format now available in dry powder

  24. MDI

  25. MDI and Spacer

  26. Easi-breathe

  27. Easyhaler

  28. Relievers – long acting • Long Acting • Examples are:

  29. Serevent Accuhaler (LABA)

  30. Oxis Turbohaler (LABA)

  31. Striverdi Respimat (LABA)

  32. Onbrez Breezhaler(LABA)

  33. Spiriva Handihaler (LAMA)

  34. Spiriva Respimat (LAMA)

  35. Seebri Breezhaler ( LAMA)

  36. EkliraGenuair ( LAMA)

  37. Incruse Ellipta ( LAMA)

  38. LABA /LAMA Combinations • Long acting • Once or twice a day • Maximal Bronchodilatation

  39. Anoro

  40. Ultibro

  41. Duaklir

  42. Spiolto

  43. LABA/ICS Combination Inhalers • Only 4 Licensed products used locally • Combine a long acting bronchodilator and an inhaled steroid • Seretide 500 Accuhaler – generic- Aerivio Spiromax/ Airflusal Forspiro/ Fusacomb Easyhaler • Symbicort 400/12 and 200/6 Turbohaler - generic is Duoresp Spiromax • Fostair 100/6 MDI and Nexthaler • Relvar Ellipta 92/22 NB Sirdupla / Sereflo /Airflusal / Aloflute- generic versions of Seretide 250 MDI- do not have COPD Licence

  44. Seretide 500

  45. Symbicort

  46. Fostair

  47. Relvar

  48. Triple Therapy • Combination of inhaled corticosteroid/ LABA/LAMA • Should only be started after seeking advice from or referring to respiratory specialist

  49. Trimbow • Two puffs twice a day- used with a spacer

  50. Trelegy • Once a day

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