COPD

Question 1

Oxygen therapy

Answer 1

usually prescribed for patients with: 
Arterial PO2 <89%, 55 mm Hg or less  
Pulmonary hypertension
Evidence of cor pulmonale or edema as a result of RHF
- with PaO2 between 55 - 60 mm Hg

Question 2

Treatment of exacerbation

Answer 2

Aggressive bronchodilators - beta-agonist, anti-cholinergics
- atrovent (ipratropium bromide) q6h
- ventolin (salbutemol)
Prednisone - 50 mg x 5 days
O2 - 88 - 92%
BiPap - very tired should see in 30 min
Antibiotics - inc. dyspnea, cough, sputum production for 48 hours

Question 3

Antibiotics used in exacerbation

Answer 3

Simple: 
- amoxicillin
- TMP-SMX
- 2nd/3rd gen cephalosporins
- macrolides
Complicated (risk factors)
- amox/clav
- fluoroquinolones

Question 4

Outpatient management

Answer 4

Preventative measures: 
- influenza vaccine
- pneumococcal vaccine
- Home O2 - room air ABG
Puffer use - what have they been on before?
- exacerbation prevention - long acting bronchodilators
Quit smoking
Pulmonary rehab
Follow up: 4 - 6 weeks