COPD!

GUIDELINES!

  • GOLD provides the following classification system: 

 


PEARLS!

  • 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

FUN FACTS!


TREATMENT ALGORITHMS (GOLD, NICE):


KEY LITERATURE: 

  • 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

RESOURCES:


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?