Who has the worst prognosis?
- Over age 60
- FEV1<50%
GOLD guidelines recommend pharmacotherapy by _____.
GOLD guidelines recommend pharmacotherapy by severity.
When should ABX be prescribed in an exacerbation?
- 2 cardinal symptoms and 1 of them is increased purulence of sputum
- Severe exacerbation requiring mechanical ventilation
According to GOLD guidelines, the below group should receive which ABX?
Group B: Patients with moderate exacerbation and risk factor(s) for poor outcome.
β-lactam/β-lactamase inhibitor (e.g., Augmentin)
What constitutes an exacerbation?
Events in the natural course of the disease characterized by a change in the patient’s baseline dyspnea, cough, and/or sputum that:
- Is beyond normal day-to-day variations
- Is acute in onset
- May warrant a change in regular medication
What are the 3 cardinal symptoms of an exacerbation?
- Increased dyspnea
- Increased sputum
- Increased sputum purulence (including color change to green/yellow)
How many days of oral steroids should be prescribed in an exacerbation?
- 5 day burst
- 10 day taper
Which of these is not a best practice?
- Use objective tests (spirometry, 6-minute walk) to confirm suspected diagnosis of COPD.
- Apply the GOLD guideline recommendations for pharmacologic and nonpharmacologic management based on disease severity.
- Partner with patients to review their at-home care setting, and consider individual’s needs, lifestyle, and preferences to maximize adherence to treatment regimens.
- Consult with pulmonologist at initial diagnosis.
Comanage/consult with pulmonologist along the continuum of care.
What 2 things improve your prognosis?
- Supplemental O2, when indicated
- Smoking cessation
According to GOLD guidelines, the below group should receive which ABX?
Group A: Patients with mild exacerbation and no risk factors for poor outcome.
- β-lactam
- Tetracycline
- Bactrim
Your patient appears to be having an exacerbation. What measurements and diagnostics can help you?
- CXR (r/o acute pneumonia, malignancy)
- ABG (if hospitalized)
- EKG
- Oxygen Saturation
What 4 things weaken your prognosis?
- Cor pulmonale
- Hypercapnia
- Tachycardia
- Malnutrition
What is outpatient management for an exacerbation?
- Bronchodilators
- Oral steroids
- Oxygen PRN
- Antibiotics (maybe)
What are potential complications of an exacerbation?
- Infections
- Pneumothorax
- Cor pulmonale
- Secondary polycythemia
- Bullous lung disease
- Acute or chronic respiratory failure
- Pulmonary hypertension
- Malnutrition
_____ are central to the symptomatic and maintenance treatment of COPD.
Bronchodilators are central to the symptomatic and maintenance treatment of COPD.
What are the 3 keys to diagnosis of COPD?
- Smoking hx
- Physical exam
- Spirometry
What are 4 common causes of exacerbations?
- Acute infection (viruses, H. influenzae, M. catarrhalis, S. pneumoniae)
- Congestive heart failure
- Pulmonary embolism
- Air pollution
How many days of bronchodilator should be prescribed in an exacerbation?
7 day minimum
According to GOLD guidelines, the below group should receive which ABX?
Group C: Patients with severe exacerbations and risk for P. aeruginosa infection.
Fluoroquinolones
With 1 cardinal symptom of an exacerbation, what 5 things do you also assess for?
- Upper respiratory infection (URI) in last 5 days
- Fever without apparent cause
- Increased wheezing, chest tightness
- Increased cough
- 20% increase in heart rate over baseline
Who has the best prognosis?
- Under age 60
- FEV1 >50%
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3: Asthma Pathophysiology14
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3: Asthma21
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3: Asthma Episode Severity21
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3: Asthma Classification31
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3: Asthma Management10
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3: Asthma Control21
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3: Asthma Medications52
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3: Status Asthmaticus3
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3: High-Risk Asthma Patients8
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3: Which Specialist?5
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3: Adult Asthma15
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3: COPD Epidemiology8
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3: COPD Pathophysiology15
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3: COPD31
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3: COPD Diagnosis24
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3: COPD Severity Classification6
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3: COPD Management19
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3: COPD Exacerbations21
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3: COPD Treatment Classification4
