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COPD Exacerbations

COPD Exacerbations. 4/23/13. Factor for COPD. More than 40 pack years history of smoking Cough greater than 3 months in two successive years. Testing for COPD. R/O Anemia, Metabolic Disorder, Alpha-one anti-trypsin deficiency Spirometry Oximetry Chest x-ray. GOLD Criteria.

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COPD Exacerbations

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  1. COPD Exacerbations 4/23/13

  2. Factor for COPD • More than 40 pack years history of smoking • Cough greater than 3 months in two successive years

  3. Testing for COPD • R/O Anemia, Metabolic Disorder, • Alpha-one anti-trypsin deficiency • Spirometry • Oximetry • Chest x-ray

  4. GOLD Criteria • Global Initiative for COPD • Criteria for Flare: • Cough increased • Increased Sputum • Dyspnea

  5. Risk Criteria • Mild risk: One flare in the last 12 months • Moderate: More than one flare in 12 months • Severe: More than two hospitalizations in the last year

  6. Predictive Factor • If admitted to the hospital, 14% die within 3 months • If PaO2 greater the 50, 6 months, 33%, 12 months 43% • If commodities like Diabetes, elderly, male, higher risk of dying • If pseudomonas infection in lungs then increased rate of infection, 59%/35%

  7. What is the cause: • 70% are URI viral bacterial • 30% environmental allergies smoke

  8. Treatment • Oxygen, O2 sat 90-94 • Neb Treatments • Albuterol q 4 hours • Duo-nebs, Seem to have better results • Can use inhaler 4-8 puffs with spacer q hourly initially • Steroids • Oral just as effective 30-60 mg daily

  9. Treatment continued • Antibiotics • Zithromax suggested as best initial choice • Pneumovax, if not already done, or more than 5 years

  10. When to transfer • Increased Respiratory Rate Greater than 30 for more than 1 hour • Unable to maintain O2 sats at greater than 90% • Decreasing mental status • Not responding to treatment

  11. Questions?

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