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Respiratory Disorders

Respiratory Disorders. Module 2. Chronic Obstructive Pulmonary Disease. Process. Step 1 . Complete Module #2 with voice overlay Step 2 . Answer the question following Module #2 Step 3 . Complete further modules or take a break. Module #2 Learning Objectives.

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Respiratory Disorders

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  1. Respiratory Disorders Module 2. Chronic Obstructive Pulmonary Disease

  2. Process • Step 1. Complete Module #2 with voice overlay • Step 2. Answer the question following Module #2 • Step 3. Complete further modules or take a break.

  3. Module #2 Learning Objectives • Explain the diagnostic features and staging of COPD • Describe non-pharmacologic and the ‘stepped’ pharmacologic therapy for COPD • List Medicare criteria for chronic O2 therapy • Describe steps for assisting patients with smoking cessation

  4. COPD: Prevalence and Cost • 15 million persons in the US • 4th leading cause of death • Cost: $15 billion/year

  5. COPD: Definition • A spectrum of chronic respiratory diseases with: • Airflow limitation • Cough • Dyspnea • Frequent pulmonary infection • Impaired gas exchange • Sputum production

  6. COPD: Diagnosis • Obtain complete PFTs • Allows staging of severity • Assesses oxygen

  7. C OPD P F T s From Images.MD

  8. COPD: Nonpharmacologic Therapy • Smoking cessation • Rehabilitation • Oxygen therapy

  9. COPD: Nonpharmacologic Therapy Smoking cessation • Ask • Advise • Assess willingness • Assist with plan

  10. Pulmonary Rehabilitation Appropriate at all stages of COPD Dyspnea is a good guide to intensity Programs need to be ongoing Goal is 20-30 minutes of sustained activity COPD: Nonpharmacologic Therapy

  11. COPD: Oxygen Therapy

  12. Pharmacotherapy: primary

  13. Pharmacotherapy: other

  14. *bronchodilators= ß-2 agonist , anticholinergics, SR-theophylline

  15. Definition= increased breathlessness, wheezing, cough, sputum Evaluation= Chest X-Ray, EKG, ABG Titrate O2 sat to 90% and recheck ABG COPD Exacerbation

  16. COPD Exacerbation: Therapy • Increase dose or frequency of bronchodilators • Consider IV theophylline • Add steroid • Add antibiotic if ↑sputum volume or purulence

  17. Severe COPD Exacerbation • IF 2 or more of the following: • Severe dyspnea • RR ≥ 25 • pCO2 45-60 • THEN NPPV reduces: • Risk of ventilation • In hospital mortality • Length of stay Images.MD

  18. Images.MD

  19. References • Hughes JR, Stead LF, Lancaster T. Antidepressants for smoking cessation. Cochrane Database Syst Rev 2002 1: 31 • www.clinicalevidence.com, Chronic Obstructive Pulmonary Disease. • Keenan SP, Sinuff T, Cook DJ , Hill NS , Which patients with acute exacerbation of chronic obstructive pulmonary disease benefit from noninvasive positive-pressure ventilation? A systematic review of the literature. Ann Intern Med 2003;138: 861 – 870 • Reuben DB, Herr KA, Pacala JT, Pollock BG, Potter JF, Semla TP, eds. Geriatrics at Your Fingertips, 7th Edition, American Geriatrics Society, New York, NY, 2005. Respiratory Diseases pp167-176 • Geriatric Review Syllabus: a core curriculum in geriatric medicine. Fifth Edition 2002-2004. E. L. Cobbs, E.H. Duthie, J.B. Murphy (Eds). • Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease, Global Initiative for Chronic Obstructive Lung Disease (GOLD) . NHLBI/WHO Workshop Report, Executive Summary. National Institutes of Health, National Heart, Lung and Blood Institute. March 2001. NIH Publication No. 2701A. http://www.goldcopd.com.

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