3: COPD Management

Question 1

How do you track disease progression and reassess severity?

Answer 1

• MMRC breathlessness assessment
• Spirometry (perform regularly)

Question 2

What is the treatment for this stage?

Stage 4: Very Severe

Answer 2

• Active reduction of risk factors
• Flu vaccine
• SABA
• 1 or more LABAs
• Pulmonary Rehab
• ICS if repeated exacerbations
• O2 therapy if chronic respiratory failure

Question 3

Upon initial diagnosis, what is the nonpharm treatment plan?

Answer 3

• Smoking cessation
• Referral for pulmonary rehab
• Regular exercise
• Psych eval for eating disorder, depression
• Nutritional eval
• Patient education on COPD and smoking cessation

Question 4

Which comorbidity should especially be monitored?

Answer 4

Cardiovascular

Question 5

What are the pharm options for COPD?

Answer 5

• SABAs (sympathomimetics)
• Anticholinergics
• LABAs (alone or combined with anticholinergic)
• ICS
• Systemic steroids
• Methylxanthines (Theophylline)

Question 6

Which type of COPD patients benefit little from mucolytic agents like Mucinex?

Answer 6

Stable patients benefit very little. More benefit with proper hydration (6-8 8-ounce glasses of water).

Question 7

After placing a patient on initial pharm therapy, when should f/u occur?

Answer 7

1 month

Question 8

What is the flow rate Rx for O₂?

Answer 8

Prescribed at a flow rate to produce 90% saturation.

Question 9

What is the treatment for this stage?

Stage 2: Moderate

Answer 9

• Active reduction of risk factors
• Flu vaccine
• SABA
• 1 or more LABAs
• Pulmonary Rehab

Question 10

What is the treatment for this stage?

Stage 3: Severe

Answer 10

• Active reduction of risk factors
• Flu vaccine
• SABA
• 1 or more LABAs
• Pulmonary Rehab
• ICS if repeated exacerbations

Question 11

T/F Cough suppressants benefit bronchitis patients over emphysema patients.

Answer 11

False. They should be avoided in all. Benefits of expectoration are more important, esp to prevent pneumonia.

Question 12

T/F COPD patients should be vaccinated for flu and pneumonia.

Answer 12

True. Vaccinate for influenza (annually) and pneumococcal pneumonia (every 5 years).

Question 13

When is O₂ therapy recommended?

Answer 13

• Cor pulmonale
• Transient (unrelated to exercise) or nocturnal desaturation
• Need for exertion-induced dyspnea prophylaxis

Question 14

What type of meals are beneficial?

Answer 14

• Small, frequent meals
• Nutritional supplements often beneficial in emphysema

Question 15

Is postural drainage beneficial for bronchitis or emphysema?

Answer 15

Bronchitis

Question 16

How often should the SABA and LABA be used?

Answer 16

• SABA = PRN
• LABA = BID

Question 17

What are the nonpharm options for COPD?

Answer 17

• Pulmonary Rehab
• O₂ Therapy
• Surgery
  
  • Bullectomy
  • Lung Volume Reduction (severe cases)
  • Lung Transplant (end-stage)

Question 18

What are the goals of COPD treatment?

Answer 18

• Reduce symptoms and improve quality of life
• Increase exercise tolerance/maximize lung function
• Decrease exacerbations
• Prevent disease progression
  
  • Smoking cessation
  • Precipitant avoidance
  • Infection prevention

Question 19

What is the treatment for this stage?

Stage 1: Mild

Answer 19

• Active reduction of risk factors
• Flu vaccine
• SABA