Case 4: Internal Medicine Flashcards
COPD: Category A
- Sx?
- Risk level?
Less symptomatic: mild or infrequent Sx (i.e. breathless with strenuous exercise or when hurrying on level ground or walking up a slight hill) or CAT <10
Low Risk:
-0 to 1 exacerbations in the past year without associated hospitalization
COPD: category A
-tx?
Short-acting bronchodilator OR combo of short-acting beta-agonist and anticholinergic PRN
COPD: category B
- Sx?
- Risk level?
More symptomatic: moderate to severe Sx (ie Pt has to walk more slowly than others of same age due to breathlessness, has to stop to catch breath when walking on level ground or at own pace, OR has more severe breathlessness) or CAT ≥10
Low risk:
0 or 1 exacerbations in the past year without associated hospitalization
COPD: category B
-Tx?
First line: regular tx with a LABA or LAMA. SABA available for symptom control PRN
For persistent Sx: Regular tx with a combo of LAMA + LABA
COPD: Category C
- Sx?
- Risk level?
Less symptomatic:
mild or infrequent Sx (ie breathless with strenuous exercise or when hurrying on level ground or walking up a slight hill) or CAT <10
High risk:
≥2 exacerbations per year with 1 or more leading to hospitalization
COPD: Category C
tx?
First choice:
-Regular tx with a LAMA; SABA PRN
For further exacerbations: Regular tx with a LAMA plus LLABA or LABA + ICS
COPD: Category D
- Sx?
- Risk level?
More symptomatic:
mod to severe sx (i.e. Pt has to walk slower than others of same age due to breathlessness, has to stop to catch breath when walking on level ground at own place, or has more severe breathlessness) or CAT ≥10
High risk:
≥2 exacerbations per year with 1 or more leading to hospitalization
COPD: category D
Tx:
first line: regular tx w/ combo of LABA + LAMA. SABA PRN
-LAMA alone if LABA contraindicated
For further exacerbations: Regular tx w/ combo of LAMA + LABA + ICS
If exacerbations cont. despite triple therapy: roflumilast (if chronic bronchitis and FEV1 less than 50%)
mMRC scores:
0-4
mMRC score: Grade 0
Not troubled with breathlessness except with strenuous exercise
mMRC score: Grade 1
Troubled by shortness of breath when hurrying on the level or walking up a slight hill
mMRC score: Grade 2
Walks slower than people of the same age on the level because of breathlessness or has to stop for breath when walking at own pace on the level
mMRC score: Grade 3
Stops for breath after walking about 100 yards or after a few minutes on the level
mMRC score: Grade 4
Too breathless to leave the house or breathless when dressing or undressing
CAT score:
- scaling: 1-5
- 8 item Patient Questionnaire
- Range of CAT scores from 0–40. Higher scores denote a more severe impact of COPD on a patient’s life.
GOLD scoring is based on ______
spirometry
