Diagnosis
What are 3 cardinal symptoms of COPD?
cough
sputum production
dyspnea
What is typical dose of albuterol for inpatient COPD patients?
2.5mg nebulized in 1-2 puffs Q1H for 2-3 doses, then Q2-3H
Which O2 delivery device allows for a more precise FiO2 and is preferred for patients at risk for hypercapnia?
Venturi Mask
What annual vaccine would you offer your COPD patient ?
Influenza
What is FEV1/FVC ratio cut off to diagnose COPD?
0.7 or less than lower limit of normal
-must be incompletely reversible after administration of bronchodilator
-absence of alternative explanation for symptoms and airflow limitation
How are DuoNebs dosed for IP COPD?
Q1H for 2-3 doses, then Q2-4H; if stable can start Q6H
What is the max flow rate for NC?
6L
What vaccine would your patient between 19-64 year qualify for?
PPSV23
What is definition of COPD exacerbation?
"an acute event characterized by worsening of the patient's respiratory symptoms that is beyond normal day-to-day variations and leads to change in medication" -GOLD
typically increased sputum production, worsening cough and increased dyspnea
What is the dose and duration for prednisone?
40mg daily for 5 days
Which O2 delivery device has flow rates from 6-10L/min?
Simple face mask
Combo Corticosteroid + LABA
What are two ways by which we classify COPD using GOLD system?
-ABCD grading: based on mMRC or CAT for symptom severity + number of exacerbation/hospitalizations
-Severity of airflow limitation
Patients with severe COPD (FEV < 30%), bronchiectasis, broad spec antibiotics in past 3 months, or systemic glucocorticoid use should also be considered for tx for what pathogen?
Pseudomonas
Which delivery device can provide inspired O2 concentration up to 90%?
Non-rebreathing mask
What are examples of combo corticosteroids + LABA (at least two please)?
Advair Diskus/HFA
AirDuo RespiClick
Breo Ellipta
Dulera
Symbicort
Wixela
67 year old male patient presenting for COPD exacerbation with FEV1 35% predicted, hospitalized once in past for exacerbation, mMRC score 3.
What is the stage of COPD using GOLD classification and ABCD score?
D
Gold 3
What 2 antibiotic classes could be used for someone with moderate COPD exacerbation and increased sputum production?
Macrolides or 2nd/3rd Gen Cephalosporin
Which offers a flow rate up to 60L/min and low levels of continuous airway pressure?
HFNC