- GOLD provides the following classification system:
- Use the mMRC dyspnea scale or the COPD assessment tool to gauge symptoms
- mMRC is basically “When do you get SOB?”
- Only 2 interventions decrease mortality in COPD:
- smoking cessation and
- home O2 (but O2 must be worn continuously 24/7 to confer mortality benefit!)
- Consider antibiotics only in moderate/severe COPD exacerbations in patients with
- “Anthonisen criteria:” (1) increased dyspnea, (2) increased sputum production, and (3) increased sputum purulence
- The BODE index offers prognostic estimates for 4-year survival in COPD
- Requires a 6-min walk test
- COPD appears to be both underdiagnosed and misdiagnosed
- Beta blockers should not be used in patients with COPD unless there’s another clear indication
- May seem obvious but we used to think they helped (Medicine is humbling!)
- Some smokers may not have COPD on PFTs, but do have clinical exacerbations. (NEJM Trial video summary here)
TREATMENT ALGORITHMS (GOLD, NICE):
- BLOCK COPD – Don’t use beta-blockers in COPD
- LOTT – Supplemental O2 doesn’t help all COPD, only, <88%
- FLAME: LABA/LAMA > LABA/ICS
- IMPACT: LAMA/LABA/ICS > LABA/LAMA or LABA/ICS; ICS may increase PNA
- TRILOGY: LAMA/LABA/ICS > LABA/ICS
- REDUCE: 5d of steroids is non-inferior to 14d steroids
- CRP and procalcitonin could help guide ABX stewardship in COPD
- Videos for learning how to use inhalers
- COPD action plans!
- Physical Exam stigmata of COPD (Stanford 25)
QUESTIONS TO PONDER!
- How do we distinguish between asthma and COPD? Is there overlap?
- What risk factors for COPD should we consider besides smoking?
- When should we screen patients for alpha-1 antitrypsin disease?
- Should Justin be allowed to make online videos in residency?
- What comorbidities are associated with COPD?
- When would you consider daily azithromycin therapy?
- What health maintenance issues should we consider for patients with COPD?
- When would you consider getting an ABG to assess hypoxemia in COPD?