COPD: essentials of diagnosis
- hx of cigarette smoking
- chronic cough, dyspnea, sputum production
- rhonchi, decreased intensity of breath sounds and prolonged expiration on physical exam
- airflow limitation on PFT that isn’t fully reversible and is progressive
late stage COPD complications
pulmonary HTN
Cor Pulmonale
Chronic Respiratory Failure
Chronic Bronchitis
- excessive secretions of bronchial mucus w/ a daily cough for >3 months for at least 2 consecutive years
BLUE BLOATER overweight d/t activity intolerance elevated hemoglobin peripheral edema d/t R heart failure rhonchi and wheezing chronic and productive cough PaCo2 elevated
Emphysema
- abnormal permanent enlargement and destruction of alveoli and terminal bronchiole (w/o obvious fibrosis)
PINK PUFFER older, thin sever dyspnea quiet chest hyper inflated lungs flattened diaphragm on CXR rare cough PaCo2 normal
Treatment of COPD:
Group A
0-1 moderate exacerbations
(not leading to hospital admit)
mmMRC 0-1
CAT <10
Bronchodilator (short or long acting)
Treatment of COPD:
Group B
0-1 moderate exacerbations
(not leading to hospital admit)
mmMRC =>2
CAT =>10
LABA OR LAMA
severe breathlessness consider initial therapy w/ 2 bronchodilators
more likely to have conordibities
Treatment of COPD:
Group C
=>2 moderate exacerbations OR =>1 leading to hospital admit
mmMRC 0-1
CAT <10
LAMA
Treatment of COPD:
Group D
=>2 moderate exacerbations OR =>1 leading to hospital admit
mmMRC =>2
CAT =>10
LAMA
OR
LAMA + LABA (severe breathlessness w/ exercise limitation)
OR ICS + LABA (eos>300)
COPD:
key points for bronchodilators
LABA and LAMA preferred over short acting EXCEPT occasional dyspnea
inhaled recommended over po
theophylline NOT RECOMMENDED unless others unavailable or unaffordable
may be started on single long-acting therapy or dual long-acting, may be escalated to 2 w/ persistent dyspnea
COPD:
key points for anti-inflammatory agents
NOT RECOMMENDED:
- long term monotherapy w/ ICS
- long term PO
- statin therapy
long term ICS may be considered w/ LABA if hx of exacerbations w/ LABD
COPD and Spirometry
REQUIRED TO MAKE DIAGNOSIS
presence of post-bronchodilator FEV1/FVC <70 confirms presence of persistent airflow limitation (+COPD)
