16. MPOC Flashcards
Lorsque vous soupçonnez un diagnostic de MPOC, tentez de le confirmer par ?
la spirométrie (p. ex. VEMS).
Encouragez vivement l’arrêt _____ chez tous les patients atteints de MPOC.
arrêt tabagique
Offrez les vaccins appropriés aux patients atteints de MPOC.
Nommez les vaccins
influenza
pneumocoque
Chez un patient atteint de MPOC apparemment stable, offrez les médicaments appropriés par inhalation (p. ex., anticholinergiques/bronchodilatateurs lorsque l’affection est réversible, essai de stéroïdes).
Référez au besoin, les patients atteints de MPOC aux autres professionnels de la santé pour améliorer la qualité de vie. Nommez des examples
inhalothérapeute
personnel de réadaptation pulmonaire
Lorsque vous traitez des patients qui présentent des exacerbations aiguës de leur MPOC, éliminez les comorbidités (p. ex., infarctus du myocarde, insuffisance cardiaque congestive, infections systémiques, anémie).
Chez les patients atteints de MPOC terminale, particulièrement ceux qui sont présentement stables, discutez, documentez et réévaluez quoi?
périodiquement leurs souhaits concernant le niveau de soin ou l’intensité des interventions thérapeutiques
Describe MPOC
Persistent respiratory symptoms and airflow limitation due to airway/alveolar abnormalities usually caused by exposure to noxious particles/gases
Describe diagnosis : MPOC (1)
Spirometry FEV1/FVC <0.70 post-bronchodilator
Describe grades : MPOC (4)
- Mild = FEV1>80% predicted
- Moderate = 50-80%
- Severe = 30 to <50%
- Very Severe <30%
Name symptoms : MPOC (4)
- Dyspnea
- Cough
- Wheeze
- Sputum production
Name scores/ways to assess symptoms : MPOC (2)
- mMRC
- COPD assessment test
Describe : mMRC (5)
- Grade 0 = Symptoms on strenuous exercise
- Grade 1 = Symptoms on hurrying on level or walking up slight hill
- Grade 2 = Walk slower than people same age because of breathlessness, or stop to breathe when walking at regular pace on level
- Grade 3 = Stop after 100m or after a few minutes on level
- Grade 4 = Unable to leave house or breathless when dressing/undressing
Describe : COPD Assessment Test (8)
Quantifies impact of COPD symptoms on patients’ overall health.
* Cough
* Phlegm
* Chest tightness
* Breathlessness
* Activities
* Confidence
* Sleep
* Energy
When to screen for Alpha-1 antitrypsin deficiency (AATD)
WHO recommends all patients with COPD should be screened once, especially if high prevalence area
Consider if
* early onset COPD
* family history of AATD
* <20py smoker
* asthma poorly responsive to therapy
Describe classic patient : Alpha-1 antitrypsin deficiency (AATD)
Classic <45yo with panlobular basal emphysema
Describe tx : MPOC (7)
- Smoking cessation, exercise
- Yearly influenza vaccine and pneumococcal vaccine (>65yo or risk)
- Bronchodilators
- Réadaptation pulmonaire pour les patients limités à l’exercice ou FEV1<50%
- Oxygen therapy for severe resting chronic hypoxemia (PaO2 <55mmHg, SaO2<88%)
- Non-invasive ventilation (CPAP) for OSA or chronic hypercapnia with history hospitalization
- Bronchoscopic and surgical treatments for advanced COPD
MPOC exacerbation most commonly triggered by what?
- respiratory viral infection (rhinovirus)
- environment (pollution, temperature)
Treatment of exacerbation MPOC : Mild
SABA (eg. 4-8 puffs inhaled q20mins up to 4h then q1-4h PRN)
+/- LAMA
Treatment of exacerbation MPOC : Moderate (2)
- Antibiotics and corticosteroids (Pred 40mg PO daily x5d) indicated if increased sputum purulence with one of: sputum volume or dyspnea (or if requires ventilation)
- Consider : Procalcitonin, Sputum cultures if recurrent or severe, r/o pseudomonas
In mild MPOC exacerbation, describe ATB tx if simple COPDE (6)
- Amoxicillin 500mg TID x 7d
- or clarithromycin 500 BID x 7d
- or azithromycin
- or cefuroxime
- or doxycycline
- or TMP-SMX
In mild MPOC exacerbation, describe ATB tx if complicated COPDE (3)
If complicated (FEV1<50%, more than 3 COPDE/y, comorbidity, oxygen needs, chronic inhaled steroid, recent antibiotic use)
- Moxifloxacin 400mg PO daily x 5d
- Levofloxacin 500mg PO daily x 7
- or Clavulin
Treatment of exacerbation MPOC : Severe (2)
- Magnesium sulfate 2g IV over 20 minutes may reduce hospitalizations (NNTB = 7)
- Hospitalization/ER visit
Describe prevention MPOC (5)
Lifestyle
- Stop smoking
- Exercise
Vaccine
- Influenza
- Pneumococcal 23-valent
Meds
- LA bronchodilators/anticholinergics
- Teach inhaler technique
- Action plan
When to go to Emergency Department
Refer
- Pulmonary Rehab
- Resp therapy/Respirology/Specialty clinic
- Smoking cessation group
