Diabetes Care

Diabetes Cycle of Care

People with medical cards who have type 2 diabetes can now have their condition thoroughly reviewed twice a year by their GP.

The new Diabetes Cycle of Care service is available to type 2 diabetes patients who have full or GP-visit medical cards.

As part of this new service, qualifying patients will visit their GP twice a year for a full structured review of their condition, including blood results, blood pressure assessment, a medication review, body mass index measurement and a symptomatic foot review.

Useful Links: Diabetes Ireland https://www.diabetes.ie

Asthma Management

Asthma is a chronic disease that is often poorly controlled in children. As a consequence children often cannot lead normal lives due to symptoms of breathlessness and cough. International evidence shows that management of asthma in primary care with a particular emphasis on self-care greatly improves the quality of life for children with this disease.

Useful links: https://www.asthma.ie/

Asthma Cycle of Care

The Asthma cycle of care will provide the key elements of best practice in the care of asthma with structured visits including education of child and parents, medicine and inhaler technique review and an individualised asthma plan for parents.

It will result in better quality of life for children, with resulting better health and wellbeing and less need to visit hospital.

COPD Management

Chronic Obstructive Pulmonary Disease (COPD)

COPD, or chronic obstructive pulmonary (PULL-mun-ary) disease, is a progressive disease that makes it hard to breathe. "Progressive" means the disease gets worse over time.

COPD can cause coughing that produces large amounts of mucus, wheezing, shortness of breath, chest tightness, and other symptoms.

Cigarette smoking is the leading cause of COPD. Most people who have COPD smoke or used to smoke. Long-term exposure to other lung irritants—such as air pollution, chemical fumes, or dust, may contribute to COPD also.

Symptoms of COPD

Damage to the lungs caused by smoking will gradually build up, so you may not notice the symptoms of chronic obstructive pulmonary disease (COPD) at first. However, they can get worse over time.

COPD does not usually become noticeable until after the age of 35. See your GP if you have the following symptoms:

increasing breathlessness when exercising or moving around
a persistent cough with phlegm that never seems to go away
frequent chest infections, particularly in winter

If you have COPD, the airways of the lungs become inflamed and narrowed. As the air sacs get permanently damaged, it will become increasingly difficult to breathe in and out.

The symptoms of COPD are often worse in the winter, and it is common to have two or more flare-ups a year. A flare-up is when your symptoms are particularly bad. This is one of the most common reasons for people being admitted to hospital in Ireland.

While there is currently no cure for COPD, the sooner the condition is diagnosed and appropriate treatment begins, the less chance there is of severe lung damage.

Treating COPD

Stop smoking

Stopping smoking is the main way for people with COPD to help themselves feel better and the only proven way to reduce the rate of the decline in lung function in people with COPD.

Stopping smoking at an early stage of the disease makes a huge difference. Any damage already done to the airways cannot be reversed, but giving up smoking prevents it from getting worse.

If COPD is in the early stage and symptoms are mild, no other treatments may be needed. But it is never too late to stop smoking. Even people with fairly advanced COPD are likely to benefit from quitting, which may prevent further damage to the airways.

Research has shown that you are up to four times more likely to give up smoking successfully if you use support along with stop-smoking medicines such as tablets, patches or gum. Ask your doctor about this or go to the www.quit.ie website.

Inhalers

If an inhaler is prescribed for you, your GP, practice nurse or pharmacist can explain how to use it. They will check that you are using it properly. Most people learn to use an inhaler successfully, but if you are having problems, a spacer or a different type of inhaler device may help you take your medicines correctly. A spacer is a device that increases the amount of medication that reaches the lungs.

Short-acting bronchodilator inhalers

Short-acting bronchodilator inhalers deliver a small dose of medicine directly to your lungs, causing the muscles in your airways to relax and open up. They also prevent hyperinflation (over expansion) of your lungs.

There are two types of short-acting bronchodilator inhaler:

beta-2 agonist inhalers, such as indacaterol, salbutamol and formoterol
antimuscarinic inhalers, such as ipratropium

The inhaler should be used when you feel breathless and this should relieve the symptoms.

Long-acting bronchodilator inhalers

If a short-acting bronchodilator inhaler does not help relieve your symptoms, your GP may recommend a long-acting bronchodilator inhaler. This works in a similar way to a short-acting bronchodilator, but each dose lasts for at least 12 hours.

There are two types of long-acting bronchodilator inhalers:

beta-2 agonist inhalers, such as salmeterol and formoterol
antimuscarinic inhalers, such as tiotropium

Steroid inhalers

Steroid inhalers, also called corticosteroid inhalers, work by reducing the inflammation in your airways.

If you are still getting breathless or having flare-ups even when taking long-acting bronchodilator inhalers, your GP may suggest including a steroid inhaler as part of your treatment. Most people with COPD will be prescribed a steroid inhaler as part of a combination inhaler.

Medicines

Theophylline tablets

If you are getting breathless or having flare-ups when using a combination of inhalers, your GP may prescribe theophylline tablets. Theophylline causes the muscles of your airways to relax and open up.

When you have been taking theophylline tablets regularly, you will need to give a blood sample. This is to measure the amount of theophylline in your blood and help your GP prescribe the appropriate dose of tablet. This will allow you to get the correct dose of theophylline while reducing the likelihood of side effects.

Due to the risk of potential side effects, such as increased heart rate and headaches, other medicines, such as a bronchodilator inhaler, are usually tried before theophylline.

Mucolytic tablets or capsules

Mucolytics, such as carbocisteine, make the mucus and phlegm in your throat thinner and easier to cough up. They are particularly beneficial for people with a persistent cough with lots of thick phlegm or who have frequent or bad flare-ups.

Antibiotics and steroid tablets

If you have a chest infection, your GP may prescribe a short course of antibiotics.

Steroid tablets may also be prescribed as a short course if you have a bad flare-up. They work best if they are taken as the flare-up starts, so your GP may give you a course to keep at home. Occasionally, you may have to take a longer course of steroid tablets. Your GP will give you the lowest effective dose and monitor you for side effects. Side effects are not usual if steroid tablets are given for less than three weeks.

Other types of treatment

Nebulisers

A nebuliser can be used for severe cases of COPD if other inhaler devices have not worked effectively. A nebuliser is a machine that administers medicine through a mouthpiece or a face mask. The medicine is in a liquid form and is converted into a fine mist. This enables a large dose of medicine to be taken in one go.

You can usually choose whether to use the nebuliser with a mouthpiece or a facemask. Your GP will advise you on how to use the nebuliser correctly.

Before you start this treatment, your GP or COPD specialist will test to make sure that the nebuliser is suitable for you.

Long-term oxygen therapy

If the oxygen level in your blood is low, you may need to take oxygen through nasal tubes, also called a nasal cannula, or through a mask. Oxygen is not a treatment for breathlessness, but it is needed for some patients with persistently low oxygen levels in the blood.

Your GP or nurse may do a test called pulse oximetry, which checks the levels of oxygen in your blood. You will probably be referred for more detailed assessment at the hospital to see whether you might benefit from long-term oxygen therapy.

Oxygen must be taken for at least 15 hours a day. The tubes from the machine are long so you will be able to move around your home while you are connected. Portable oxygen tanks are available if you need to use oxygen away from home.

Do not smoke when you are using oxygen. The increased level of oxygen that is produced is highly flammable, and a lit cigarette could trigger a fire or an explosion.

Non-invasive ventilation (NIV)

Non-invasive ventilation (NIV) helps a person breathe artificially. You may receive it if you are taken to hospital because of a flare-up. You may be referred to a specialist centre to see if you are suitable for NIV. It works by pushing air into your lungs through a mask covering the nose or face.

Pulmonary rehabilitation programmes

Pulmonary rehabilitation is a programme of exercise and education designed to help people with chronic lung problems. It can increase your exercise capacity, mobility and self-confidence.

Pulmonary rehabilitation is based on a programme of physical exercise training tailored to your needs. It usually involves walking or cycling, and arm and strength-building exercises. It also includes education about your disease for you and your family, dietary assessment and advice, and psychological, social and behavioural changes designed to help you cope better. A rehabilitation programme is provided by a multidisciplinary team, which includes respiratory nurse specialists, physiotherapists and dietitians. Pulmonary rehabilitation takes place in a group and the course usually lasts for about six weeks. During the course, you will learn more about your COPD and how to control your symptoms. Pulmonary rehabilitation can greatly improve your quality of life.

Surgery

Lung surgery may be an option for some people with certain types of COPD. This may involve removing a section of the lung that's no longer working, called lung volume reduction surgery (LVRS), to give the remaining lung more room to work. Surgery works best in people who have disease that is worse in the upper lobes of their lungs.

Most people who have this surgery should do better than people not having surgery for at least three years. However, about one person in four gets no benefit from the operation, and about one person in twenty dies during or shortly after surgery.

Lung transplantation is a realistic option for only a very small number people with COPD. It is a high-risk operation and you will need to take anti-rejection medication for the rest of your life.

Treating a flare-up

A flare-up is when your symptoms are particularly bad. If you have a flare-up of your COPD symptoms, you may be advised to increase the dose of the treatments you usually take. For example, you may need to increase the dose of your inhalers or tablets. Some people may need to use a spacer or a nebuliser for their inhaled therapy.

You may also need to take extra treatments during the flare-up, such as adding a further inhaler or tablet to what you usually take. It is common to take a short course of antibiotics or steroid tablets during a flare-up.

Some people need to go into hospital for more intensive treatment during a flare-up. Other people are treated with 'hospital at home' schemes, where experienced health professionals come to their home regularly. Your healthcare team will recommend the type of care that is best for you.

Research has shown that 'hospital at home' works as well as hospital admission in improving people's condition, and that people with COPD prefer it.