Chapter 36_ COPD.docx - Patient Group Recommended Tx...

Patient
Group
Recommended Tx Assessment Escalation
A A bronchodilator
SAMA or SAMA PRN
LABA or LAMA
Sx controlled→
Sx not well controlled→
Continue initial tx
Try a different class of
bronchodilator as monotx
B LAMA or LABA Persistent sx→ LAMA + LABA
C LAMA (preferred because has a greater impact on
exacerbation rates)
Further exacerbations→ LAMA + LABA or LABA + ICS
D LAMA + LABA or LABA + ICS Persistent sx and further
exacerbations→
LAMA + LABA + ICS
CHAPTER 36 COPD
● Spirometry is required to assess lung function and
make a dx for COPD
○ Post bronchodilator FEV1/FVC<0.70
confirms a dx of COPD
○ Gold 1: mild; FEV1 > 80%
○ Gold 2: moderate; FEV1 50-80%
○ Gold 3: severe; FEV1 30-50%
○ Gold 4: very severe; FEV1 <30%
● mMRC dyspnea scale: assess breathlessness and
scores range from 0 (only breathless with exercise)
to 4 (too breathless to leave the house/do normal
daily activities)
● CAT score: assesses all sx; scores range from 0-40%;
higher scores→ worse sx
● >2 exacerbations/year→ frequent exacerbators
● Combined Assessment: sx assessment and risk of
exacerbations drive tx options
● Non-Drug Tx:
○ Smoking cessation is the only method to
slow the progression of COPD
○ Annual flu vaccine and pneumococcal
vaccinations dec the risk of hospitalizations
○ Assess inhaler technique and adherence to
improve outcomes
○ Long term oxygen tx for patients with
severe resting hypoxemia inc survival
● Drug tx: only help with sx and prevent
complications
○ Each tx is personalized based on combined
assessment
○ First line: bronchodilator
○ SABAs & SABAs added PRN
○ If regular use is required, LAMAs or LABAs
should be used
○ Combining different bronchodilators from