COPD

Background

• Airflow obstruction as measured by post-bronchodilator FEV1 : FVC < 0.70
• Never withhold O2 if required to maintain minimum acceptable O2 saturation level

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