Regular Symptoms––dyspnea at rest or exertion, cough, sputum. Use COPD Assessment Test (CAT) or mMRC Breathlessness Scale to follow course of disease.
Exacerbations––two or more in the past year, especially if FEV1<50% predicted suggests high risk.
Oxygenation––severe hypoxemia: resting O2 sat< 88% or arterial pO2<55 mmHg episodic hypoxemia: exercise or nocturnal desaturation.
Emphysema––reduced density on CT scan, can be localized, abnormal high lung volumes, abnormal low diffusion capacity.
Chronic bronchitis––cough, sputum most days for at least 3 months in at least 2 years.
Comorbidities––defining and treating comorbid conditions, particularly cardiovascular, are critical components of COPD care.
Therapy guided by diagnosis and assessment of severity domains––
- Each Domain requires separate treatment consideration. For example, if regular symptoms are present, an exercise program needs to be considered regardless of what other domains are present. First line therapy is red. Second line choices are green. The various treatments can generally be combined as needed, but fixed combinations should not be combined with equivalent individual components.
- Short acting bronchodilators are rescue medications for acute dyspnea. Frequent use suggests the need for addition of a long acting bronchodilator or other adjustments in therapy.
- Theophylline may be an additional option for some patients potentially improving lung function and symptoms.
These special considerations should be applied to all with COPD:
- Smoking cessation
- Alpha-1 testing
It is also recommended to your monitor patient’s health status with the COPD Assessment Test (CAT) , or the modified Medical Research Council (mMRC) Breathlessness Scale.
To access these documents and additional educational materials please Click Here.
Have all the important diagnosis and treatment info in your pocket! These Pocket Consultant Cards are free to download! Check them out or order them from the Online Catalogue.
You can also order free Institutional Kits which include the pocket cards, along with a slide deck for Grand Rounds, a manuscript of published guidelines, and instructions for distribution and system integration within health care systems.