COPD

Question 1

What is critical to understand in a COPD patient?

Answer 1

the disease staging

**So we know where we started (how good they can get) and how bad they can get

Question 2

What are some in-patient treatments for COPD?

Answer 2

O2, inhalants, systemic steroids, and Abx

Question 3

What are some sxs of a COPD exacerbation?

Answer 3

WHO definition = worsening of sxs that is beyond normal day-to-day variations and leads to changes in meds
Increased cough, sputum, and worsening dyspnea

Question 4

What will we see on PE with a COPD exacerbation?

Answer 4

wheezing, tachypnea, increased respiratory effort (2-3 word sentences, tripoding, accessory muscles, hypoxia)

Question 5

If the FEV1 is greater than 60% predicted – what severity are they?

Answer 5

Mild

Question 6

If the FEV1 is less than 60% predicted – what severity are they?

Answer 6

Moderate

Question 7

If the FEV1 is less than 30% predicted – what severity are they?

Answer 7

Severe!

Question 8

At what point do you consult with a pulmonologist?

Answer 8

Vapotherm (to wash out upper airway expired CO2 and replacing it with high oxygenated O2 – high flow + positive pressure)
PPV (blows air into the lungs)
Intubation (last resort!)

Question 9

What are some inhalants we can use for COPD exacerbation?

Answer 9

Beta adrenergic agonists (albuterol)

Anticholinergic agents (ipratropium – every 4-6 hours or Tiotroprium – once daily)

Question 10

If a patient is taking Tiotroprium at home, should we start Ipratropium while in the hospital?

Answer 10

NO

Question 11

When treating a COPD exacerbation with steroids, where do you start?

Answer 11

Start with Parenteral steroids (Methylprednisone or Solu-Medrol) x 1-2 days

THEN PO steroids (Prednisone) 40-60mg

Question 12

How should we taper steroids?

Answer 12

20mg tab

3 tab x 3 days → 2 tabs x 3 days → 1 tab x 3 days → One ½ tab x 3 day

Question 13

What types of Abx do we use for COPD exacerbations? When?

Answer 13

Moderate or severe COPD with complications
FEV greater than 50 = Macrolides
FEV less than 50 = Floroquinolones (Maxifloxacin – watch for QT prolongation)

Question 14

Beta 2 will act on what part?

Answer 14

The muscles

Question 15

Anticholinergics will act on what?

Answer 15

Continue to relax muscle

Question 16

what will the steroids act on?

Answer 16

The skin like type tissue (inflammation)

Question 17

What’s the average length of stay for hospital stay for a COPD patient?

Answer 17

5 days

Question 18

How do we treat our COPD patient initially?

Answer 18

Oxygen, albuterol, solu-mederol

Question 19

How does treatment change day 2-3?

Answer 19

Change to PO steroids (prednisone)

Wean O2

Encourage patient to ambulate

Consider PT/OT eval

Question 20

How does your treatment change just before D/C (start the day before!!)?

Answer 20

All meds should be PO

Check a formal overnight O2 desaturation study + Hallway ambulatory study

Make sure they have good follow-up

Question 21

What should we remember with COPD patients in the hospital setting?

Answer 21

Expect the unexpected (if it goes south get ABG → call pulmonologist)

Set realistic goals

Know the length of stay may be longer

Start early assessing and getting ready to go home (especially for O2)

Question 22

What is the insurance threshold for at home O2?

Answer 22

88%