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COPD. Management of Stable COPD Shyam Rao May 2014. Objectives . Briefly review the GOLD classification of COPD Understand treatment options based on the GOLD classification of the disease Review non-pharmacologic treatment options. Case.

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slide1

COPD

Management of Stable COPD

Shyam Rao

May 2014

objectives
Objectives
  • Briefly review the GOLD classification of COPD
  • Understand treatment options based on the GOLD classification of the disease
  • Review non-pharmacologic treatment options
slide3
Case
  • A 65-year-old woman is evaluated in a follow-up examination for dyspnea, chronic cough, and mucoid sputum; she was diagnosed with chronic obstructive pulmonary disease 3 years ago. The patient has a 40-pack-year history of cigarette smoking, but quit smoking 1 year ago. She is otherwise healthy, and her only medication is inhaled albuterol as needed. • On physical examination, vital signs are normal. Breath sounds are decreased, but there is no edema or jugular venous distention. Spirometry shows an FEV 1 of 62% of predicted and an FEV1/FVC ratio of 65%. Chest radiograph shows mild hyperinflation. Which of the following is the most appropriate therapy for this patient?
  • A-Add a long-acting β2-agonist
  • B-Add an inhaled corticosteroid
  • C-Add an oral corticosteroid
  • D-Add theophylline and montelukast
  • E-Continue current albuterol therapy
slide4
GOLD
  • Global initiative for chronic obstructive lung disease
  • Based on 3 different criteria
    • Symptoms
    • Severity of airflow limitation
    • Risk of exacerbation
refractory disease
Refractory Disease
  • Theophylline: watch for toxicity levels but can be added on to category B, C, D as an additive treatment
  • PDE4 inhibitor: decrease inflammation and improve airway smooth muscle relaxation
non pharmacologic
Non-pharmacologic
  • Oxygen
  • Smoking Cessation
  • Secretion clearance
  • Vaccines: pneumococcal and influenza
  • Rehabilitation
  • Surgery: Lung Volume Reduction Surgery and transplant
lets go back to the case
Lets go back to the case
  • A 65-year-old woman is evaluated in a follow-up examination for dyspnea, chronic cough, and mucoid sputum; she was diagnosed with chronic obstructive pulmonary disease 3 years ago. The patient has a 40-pack-year history of cigarette smoking, but quit smoking 1 year ago. She is otherwise healthy, and her only medication is inhaled albuterol as needed. • On physical examination, vital signs are normal. Breath sounds are decreased, but there is no edema or jugular venous distention. Spirometry shows an FEV 1 of 62% of predicted and an FEV1/FVC ratio of 65%. Chest radiograph shows mild hyperinflation. Which of the following is the most appropriate therapy for this patient?
  • A-Add a long-acting β2-agonist
  • B-Add an inhaled corticosteroid
  • C-Add an oral corticosteroid
  • D-Add theophylline and montelukast
  • E-Continue current albuterol therapy
summary
Summary
  • GOLD criteria and categories were designed to provide specific treatment to patients not only based on airway involvement but also symptoms and risk of exacerbations
  • Treatment should be based on the GOLD criteria and advanced based on the criteria
  • Overall, general guidelines would be to start with short acting bronchodilators and expanding to long acting bronchodilators as the symptoms and severity of the disease worsen