COPD: Difference between revisions

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==Exacerbation==
==Exacerbation==


 
#Albuterol
1. Albuterol
#Atrovent
 
#Steroids: Prednisone 40mg po qday x 5-10d
2. Atrovent
#Abx
 
#*Levaquin (sick)
3. Steroids
#*Doxy (outpt) sputum change
 
#CXR
    Prednisone 40mg po qday x 5-10d
#BiPap/Intubation
 
#Carefull with O2 & hypoxic drive
4. Abx
 
    Levaquin (sick)
 
    Doxy (outpt) sputum change
 
5. CXR
 
6. BiPap/Intubation
 
7. Carefull with O2 & hypoxic drive


   
   
==Maintenance==
==Maintenance==


 
#B-agonist
1. B-agonist
#*Short: albuterol 90µg/inh 1-2 q4-6h prn; neb 2.5mg q4-6h prn
 
#*Long:  Salmeterol 50µg/inh 1 bid
    Short: albuterol 90µg/inh 1-2 q4-6h prn; neb 2.5mg q4-6h prn
#*Formoterol MDI 12µg/INH 1  bid; neb 20µg bid
 
#*Arfomoterol neb 15µg bid
    Long:  Salmeterol 50µg/inh 1 bid
#Anticholinergic
 
#*Short: ipratriopium 17µg/INH 2xINH 4x/d up to 12; neb 0.5mg q6-8h
              Formoterol MDI 12µg/INH 1  bid; neb 20µg bid
#*Long: tiotropium 18µg/INH 1xINH qam
 
#Steroids (inhaled)
              Arfomoterol neb 15µg bid
#*Fluticasone (dry powder) 250µg/INH  1-2 bid; (aerosol) 220µg 1-2INH bid
 
#*Budesonide 160µk 2 inh bid
2. Anticholinergic
#*Beclomethasone 80µg/inh 2INH bid
 
#*Mometasone 220µg/INH 1-2INH bid
    Short: ipratriopium 17µg/INH 2xINH 4x/d up to 12; neb 0.5mg q6-8h
#Combination
 
#*Albuterol-Ipratropium 90/18 2INH 4xd up to 12
    Long: tiotropium 18µg/INH 1xINH qam
#*Advair Diskus = Fluticasone-salmeterol (dry powder): 250/50 1INH bid
 
#*Budesonide-Formoterol: 160/4.5 2INH bid
3. Steroids (inhaled)
#Home O2
 
#*Indicated if PaO2 < 55mmHg or O2 Sat < 88% RA
    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%
Goal is 18h/day including sleep with flow rate that maintain sat > 90%
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==Source==
==Source==


DONALDSON 1/06, NEJM 4/10
DONALDSON 1/06, NEJM 4/10

Revision as of 17:03, 2 March 2011

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

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