COPD managment Flashcards
GOLD 1 airflow limitation
FEV1 > 80% predicted
GOLD 2 airflow limitation
FEV1 50-80% of predicted
GOLD 4 airflow limitation
FEV1 <30% of predicted
GOLD 3 airflow limitation
FEV1 30-50% of predicted
Add mMRC Grades
Mild exacerbation Tx
only with SABA
Moderate exacerbation Tx
SABA plus oral antibiotics or OCS
what is the benefit of oral corticosteroid’s in COPD?
Helps to improve lung function, oxygenation and reduce recovery time.
Severe exacerbation treatment
Hospitalization with or without resp. failure. May need NIV (very beneficial), intubation/ventilation.
Group A combined assesment
Low risk low symptoms
- GOLD 1 or 2
- mild to moderate airflow limitation
- 0-1 exacerbations per year
- mMRC 0-1
- CAT <10
Group B combined assessment
Low risk more symptoms
- GOLD 1 or 2
- mild to moderate airflow limitation
- 0-1 exacerbations per year
- mMRC 2-4
- CAT >10
Group C combined assessment
High risk less symptoms
- GOLD 3 or 4
- Severe to very severe airflow limitation
- >2 exacerbations/yr
- mMRC 0-1
- CAT<10
Group C combined assessment
High risk less symptoms
- GOLD 3 or 4
- Severe to very severe airflow limitation
- >2 exacerbations/yr
- mMRC 0-1
- CAT<10
Group D combined assessment
High risk More symptoms
- GOLD 3 or 4
- Severe or very severe airflow limitation
- >2 exacerbations per year
- mMRC 2-4
- CAT>10
Group A treatment
short acting bronchodilator
ex) ventolin (salbutamol) atrovent (ipatropium)
Group B treatment
LAMA or LABA
ex) serevent (salmeterol) or Spiriva (tiotropium)
Group C treatment
LAMA - better effect at reducing exacerbations
ex) spiriva (tiotropium)
Group D treatment
LAMA or LAMA/LABA
Add ICS to either of these (LABA/ICS or triple) if eosinophil count is >300 or >100 with recent hospitalization
When to add PDE4 inhibitor
when eosinophil levels are <100 and triple therapy is not effective
Triple inhaled therapy
LABA/LAMA taken with ICS
What can be done for a Pt who develops further exacerbations on LABA/LAMA
escalation to LABA/LAMA/ICS
add a PDE4 inhibitor or antiobiotiuc such as azithromin if blood eosinophil <100 cell/ul
what is AECOPD
DEFINED BY gold as an acute worsening of resp symptoms that resuly in requirment for additional therapy
What can prevent/ treat exacerbation
- NIV
- Antibiotics when indicated (duration= 5-7 days)
- Treat underlying causes.
how long do AECOPD symptoms usually last
7- 10 days some longer
- contribute to disease progression
Purulent discharges indicate what?
Infection (Evidence that the body response has started to destroy bacteria)
