COPD Flashcards
What is critical to understand in a COPD patient?
the disease staging
**So we know where we started (how good they can get) and how bad they can get
What are some in-patient treatments for COPD?
O2, inhalants, systemic steroids, and Abx
What are some sxs of a COPD exacerbation?
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
What will we see on PE with a COPD exacerbation?
wheezing, tachypnea, increased respiratory effort (2-3 word sentences, tripoding, accessory muscles, hypoxia)
If the FEV1 is greater than 60% predicted – what severity are they?
Mild
If the FEV1 is less than 60% predicted – what severity are they?
Moderate
If the FEV1 is less than 30% predicted – what severity are they?
Severe!
At what point do you consult with a pulmonologist?
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!)
What are some inhalants we can use for COPD exacerbation?
Beta adrenergic agonists (albuterol)
Anticholinergic agents (ipratropium – every 4-6 hours or Tiotroprium – once daily)
If a patient is taking Tiotroprium at home, should we start Ipratropium while in the hospital?
NO
When treating a COPD exacerbation with steroids, where do you start?
Start with Parenteral steroids (Methylprednisone or Solu-Medrol) x 1-2 days
THEN PO steroids (Prednisone) 40-60mg
How should we taper steroids?
20mg tab
3 tab x 3 days → 2 tabs x 3 days → 1 tab x 3 days → One ½ tab x 3 day
What types of Abx do we use for COPD exacerbations? When?
Moderate or severe COPD with complications
FEV greater than 50 = Macrolides
FEV less than 50 = Floroquinolones (Maxifloxacin – watch for QT prolongation)
Beta 2 will act on what part?
The muscles
Anticholinergics will act on what?
Continue to relax muscle
what will the steroids act on?
The skin like type tissue (inflammation)
What’s the average length of stay for hospital stay for a COPD patient?
5 days
How do we treat our COPD patient initially?
Oxygen, albuterol, solu-mederol
How does treatment change day 2-3?
Change to PO steroids (prednisone)
Wean O2
Encourage patient to ambulate
Consider PT/OT eval
How does your treatment change just before D/C (start the day before!!)?
All meds should be PO
Check a formal overnight O2 desaturation study + Hallway ambulatory study
Make sure they have good follow-up
What should we remember with COPD patients in the hospital setting?
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)
What is the insurance threshold for at home O2?
88%
