Chapter 36_ COPD.docx - Patient Group Recommended Tx Assessment Escalation A A bronchodilator SAMA or SAMA PRN LABA or LAMA Sx controlled\u2192 Sx not well

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

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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
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