Flashcards in COPD Deck (8):
What are some causes of possible COPD exacerbations?
- using the puffers correctly?
- infective (systemic or RTI)
- HF/pulmonary HTN
- metabolic disturbance
- poor treatment compliance
How do you diagnose and monitor COPD?
1) spirometry or RFT:
- FER <70%
- FEV1 <80%
2) SpO2 - if <92% on >2 occasions when resting (get an ABG)
3) special test if:
- minimal COPD RFs (<5year smoking, young onset)
- exercise test (advanced disease)
- alpha1 antitrypsin - if young.
- clinical assessment
- mild/mod do FEV1 + FVC every 12 months
- severe - ABGs if SpO2 <92% every 6 months.
Definition of COPD?
chronic progressive irreversible airway disease _ parenchymal destruction:
- emphysema (alveoli wall destruction)
- chronic bronchitis >3 months productive cough >2 consecutive years
- small airway disease
What is COPDX?
C - confirm diagnosis
confirm with spirometry, if its substantially reversible (FEV1 >400ml) treat for asthma.
O - optimise function
treat comorbidities (e.g. osteoporosis)
P - prevent deterioration
smoking cessation (nicotine replacement/varenicline)
flu vaccine, pneumococcal vaccine
mucolytics and LT O2 therapy
D - develop care plan
multidisciplinary care plans
enhance QOL, include family, allow them to take responsibility
X - manage exacerbations
systemic corticosteroids and antibiotics (mild amoxy + doxy, mod benpen + doxy, severe ceft/cefotaxime) as needed
controlled O2 delivery and bronchodilators
early diagnosis and management
Outline the GOLD classification for treatment?
Stage 1 = FEV1 >80%
- short acting bronchodilator PRN
- SABA (salbutamol)
- SAMA (ipratropium)
- or combo
Stage 2 = FEV1 50-80%
- pulmonary rehab
- long acting bronchodilator
- LABA (salmeterol)
- LAMA (tiotropium)
Stage 3 = 30-50%
- +ICS (triple therapy) if repeat exacerbations
- seretide (fluticasone + salmeterol)
- symbicort (budesonide + formoterol)
Stage 4 = <30% or <50% + resp failure
- long term O2 therapy (criteria):
- PaO2 <55,
- PaO2 55-60 with pul HTN
- non smoker
How would you direct a COPD consult?
S - smoking cessation
M - medication (inhaler, vaccine, corticosteroids)
O - oxygen
K - komorbidity (cardiac, OSA, OP, depression, asthma)
E - exercise/rehab
S - surgery
How do the Aus Guidelines and GOLD treatment guidelines differ?
their FEV1 % predicted has different mild/mod/severe categories.
<30% very severe