COPD therapeutic treatment algorithm Flashcards
3 main components of COPD
chronic bronchitis
emphysema
inflammation
what is emphysema
abnormal enlargement of the airspace accompanied by destruction of alveolar walls
structural changes associated with emphysema
alveolar destruction and reduced elasticity
what is chronic bronchitis and what are the structural changes associated with it
Presence of cough and sputum production for atleast 3 months in each of the two consecutive years.
structural changes include airway narrowing due to fibrosis and smooth muscle inflammation
KEY concepts of COPD
preventable
non-reversible
progressive persistent airflow limitation
what are the 3 hallmark symptoms of COPD
chronic cough, sputum production, dyspnea
COPD signs
increased respiratory rate
decreased breath sounds
prolonged expiration
hyperinflation
lips pursing on expiration
What is required to diagnose COPD
spirometry
What confirms airflow limitation
FEV/FVC<0.7
What are some common causes for COPD exacerbations
respiratory tract infection
(viral, bacterial) viral more common
air pollution
1/3 are unknown
what are some treatment options for COPD
SABA (albuterol) with or without ipratropium
systemic corticosteroid- prednisone 40 mg for 5 days
Antibiotics- must have cardinal symptoms
what are the 3 cardinal symptoms that would require antibiotic use
sputum purulence
sputum volume
dyspnea
sputum purulence is a requirement and must have 2/3 symptoms
discharge criteria for COPD
clinically stable for 12-24 hours
inhaled SABA not required more than every 4 hours
patient is able to walk across the room
able to use LABA
spirometric classifications of COPD
GOLD 1 FEV 80 and above
GOLD 2 FEV between 50 and 79
GOLD 3 30 to 49
GOLD 4 29 and below
group with more symptoms are in _______ and __________
B and D
Groups with more exacerbations are in ____ and _________
C and D
symptom assessment mMRC grades
mMRC 0- only get breathless with strenuous exercise
mMRC 1- SOB when walking up a hill
mMRC 2- walk slower than people of the same age due to breathlessness
mMRC 3- stops for breath after 100 meters
mMRC- too breathless to leave house
where are patients grouped in (A, B, C, D) according to CAT and mMRC
CAT 10 and up and mMRC greater than 1 is grouped B and D
CAT less than 10 and mMRC 0-1 is grouped A and C
Where are patients grouped based on exacerbations and hospitalizations (A,B,C,D)
0-1 exacerbations is A or B
2 and up is C or D
Any hospitalization is C or D
Initial treatment for each Group (except D)
Group C- LAMA
Group A- bronchodilator
Group B- LABA or LAMA
initial treatment for group D
LAMA
LAMA/LABA if CAT is greater than 20
ICS/LABA if eosinophil count is more than 300 cells/ul or
If more than 100 cells/ul and 2 or more exacerbations
or 1 hospitalization
How to get dyspnea under control in COPD
If COPD being treated by LABA or LAMA, just add the other one. (LABA+LAMA)
If patient sees no changes in results with ICS+LABA switch to
ICS+LABA+LAMA
When to use roflumilast in COPD
FEV 1 less than 50 percent and bronchitis (add azithro for former smokers)
step by step treatment of COPD
- LAMA or LABA
- LAMA & LABA or LABA +ICS
- if eosinophil is 100 or more use LABA + LAMA + ICS
- if FEV1 less than 50 use roflumilast
use azithro in former smokers
When to use ICS
