Chronic COPD
Assess Severity
Mild: FEV1 >80% (but FEV/FVC <0.7 and symptomatic)
Mod: FEV1 50-79%
Severe: FEV1 30-49%
Very Severe: FEV1 < 30%
General Measures
Review 1-2x/yr
Stop smoking
Specialist nurse
Nicotine replacement therapy
Bupropion, varenicline (partial nicotinic agonist)
Support programme
Pulmonary rehabilitation / exercise
Rx poor nutrition and obesity
Screen and Mx comorbidities
e.g. cardiovasc, lung Ca, osteoporosis
Depression
Influenza and pneumococcal vaccine
Air travel risky if FEV1<50%
Breathlessness and/or exercise limitation
Exacerbations or persistent breathlessness
if chronic productive cough
Mucolytics = Carbocisteine (CI in PUD)
click to edit
Persistent exacerbations or breathlessness
LTOT
= long term oxygen therapy
Surgery
Recurrent pneumothoraces
Isolated bullous disease
Lung volume reduction
SABA and/or SAMA (ipratropium) PRN
SABA PRN may continue at all stages
FEV1 ≥50%: LABA or LAMA (tiotropium) (stop SAMA)
FEV1 <50%: LABA+ICS combo or LAMA
LABA+LAMA+ICS
500ug fluticasone BD
1000ug beclometasone BD
Consider
Roflumilast / theophylline (PDIs)
home nebs
Aim: PaO2 ≥8 for ≥15h / day (↑ survival by 50%)
For whom?
- Clinically stable non-smokers c¯ PaO2 <7.3 (stable on two occasions >3wks apart)
- PaO2 7.3 – 8 + PHT
- cor pulmonale
- polycythaemia
- nocturnal hypoxaemia
- Terminally ill pts.