COPD

Definition

Airflow obstruction as measured by spirometry isdefined as a ratio of the postbronchodilator FEV1 : FVC < 0.70

Exacerbation

1. Albuterol

2. Atrovent

3. Steroids

    Prednisone 40mg po qday x 5-10d

4. Abx

    Levaquin (sick)

    Doxy (outpt) sputum change

5. CXR

6. BiPap/Intubation

7. Carefull with O2 & hypoxic drive

Maintenance

1. B-agonist

    Short: albuterol 90µg/inh 1-2 q4-6h prn; neb 2.5mg q4-6h prn

    Long:  Salmeterol 50µg/inh 1 bid

              Formoterol MDI 12µg/INH 1  bid; neb 20µg bid

              Arfomoterol neb 15µg bid

2. Anticholinergic

    Short: ipratriopium 17µg/INH 2xINH 4x/d up to 12; neb 0.5mg q6-8h

    Long: tiotropium 18µg/INH 1xINH qam

3. Steroids (inhaled)

    Fluticasone (dry powder) 250µg/INH  1-2 bid; (aerosol) 220µg 1-2INH bid

    Budesonide 160µk 2 inh bid

    Beclomethasone 80µg/inh 2INH bid

    Mometasone 220µg/INH 1-2INH bid

4. Combination

    Albuterol-Ipratropium 90/18 2INH 4xd up to 12

    Advair Diskus = Fluticasone-salmeterol (dry powder): 250/50 1INH bid

    Budesonide-Formoterol: 160/4.5 2INH bid

5. Home O2

Indicated if PaO2 < 55mmHg or O2 Sat < 88% RA

Goal is 18h/day including sleep with flow rate that maintain sat > 90%

Source

DONALDSON 1/06, NEJM 4/10