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COPD Chronic Obstructive Pulmonary Disease

COPD Chronic Obstructive Pulmonary Disease

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An overview of COPD symptoms, diagnosis and management.
An overview of COPD symptoms, diagnosis and management.

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Published by: adultmedicalconsultants on Nov 19, 2010
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10/03/2013

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GOLD Stage

Mild
I

Moderate
II

ModSevere
III

Severe
IV

FEV1/FVC<70%

FEV1/FVC <70%FEV1/FVC <70%

FEV1/FVC <70%

FEV1>80%

FEV150-79%

FEV130-49%

FEV1<30%

OR <50% with Chronic
Respiratory Failure

Investigations

Screening
Spirometry

Pre-&Post-
Bronchodilator
Spirometry

Annual
PFT, ABG, CXR

PFTs every 6 months
Annual ABG, CXR

Treatment Options

Smoking Cessation
Pneumococcal Vaccineand Annual Influenza Vaccine
Prescribe Short Acting Bronchodilator whenneeded

Tiotropium +/-ShortActing Bronchodilator + Pulmonary Rehab

Tiotropium +Long Acting Beta
Agonist +/-Methylxanthines
Supplemental Oxygen as needed
Lung Volume
Reduction
Surgery

The Role of Long Acting Bronchodilators in the Management of Stable COPD Chest 2004; 125:249-259

Consider addition of inhaled corticosteroids [TORCH trial]
Fewer moderate and severe exacerbations in patients taking inhaled steroids
compared with those taking only long acting bronchodilators
No change in number of hospitalizations for severe exacerbations or change in
mortality UpToDate

Martha Burk, MD

Treatment Options Acute Exacerbations

Cough
increases in
frequency or
severity

Sputum
increases in
volume or
character

Dyspnea
increases

50-60% due
to infection

Supplemental oxygen

Goal 90-94%

Short acting bronchodilators

Albuterol and Ipratropium combined have a greater
effect than either individually

Steroids

IV administration for those intolerant of oral intake
Oral steroids are as effective as IV

Dosed as 1mg/kg IBW (Ideal Body Weight)

60mg orally for 7 days

Antibiotics, if appropriate

No Benefit

Mucolytics, methylxanthines or chest physiotherapy

Martha Burk, MD

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