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COPD

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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COPD

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  1. COPD Management of Stable COPD Shyam Rao May 2014

  2. Objectives • Briefly review the GOLD classification of COPD • Understand treatment options based on the GOLD classification of the disease • Review non-pharmacologic treatment options

  3. 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

  4. GOLD • Global initiative for chronic obstructive lung disease • Based on 3 different criteria • Symptoms • Severity of airflow limitation • Risk of exacerbation

  5. GOLD Criteria for Severity

  6. GOLD criteria assessment

  7. GOLD A and B

  8. GOLD C and D

  9. 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

  10. Non-pharmacologic • Oxygen • Smoking Cessation • Secretion clearance • Vaccines: pneumococcal and influenza • Rehabilitation • Surgery: Lung Volume Reduction Surgery and transplant

  11. 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

  12. 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

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