CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) NR667: Bridget Aliff

COPD should be considered in any patient with chronic cough, sputum production, and dyspnea (GOLD, 2019). Spirometry is required for diagnosis as it is the most objective measurement of airflow limitation, a FEV1/FVC <70 post-bronchodilator confirms diagnosis (GOLD, 2019).

CRITERIA FOR DIAGNOSIS

-Spirometry classification of airflow limitation severityCHRONIC OBSTRUCTIVE PULMONARY DISEASE

-Modified MRC dyspnea scale -CAT assessment

-The refined ABCD assessment tool (GOLD, 2019)

COMMON DIAGNOSTICS

-Smoking cessation including electronic cigarettesCHRONIC OBSTRUCTIVE PULMONARY DISEASE

-Supplemental oxygen (Lopez et al., 2020)

-Both the Flu and pneumonia vaccinations are recommended (Gold, 2019)

NON- PHARMOCOLOGICAL TREATMENT

COPD is a progressive condition that causes pathological changes to the airways (Hollier, 2018). The condition is due to an exaggerated inflammatory process that is caused by irritants or pollutants and the inflammatory process causes remodeling of the tissue which overtime worsens symptoms (Hollier, 2018).CHRONIC OBSTRUCTIVE PULMONARY DISEASE

WHAT IS COPD?

PHARMACOLOGIC TREATMENT The goal of treatment of COPD is to reduce the

severity of symptoms, reduce the frequency of

exacerbations, and improve exercise tolerance.

There fore treatment plans are individualized

(GOLD, 2019)

Oral glucocorticoids are reserved for the treatment of acute exacerbations due to the systemic effects if used long-term (GOLD, 2019).

ORAL GLUCOCORTICOIDS

-The use of continuous prophylactic daily antibiotics in patients with frequent exacerbations has been shown to reduce the incidence of exacerbations (GOLD, 2019)

ANTIBIOTICS

Regular treatment with mucoltytics has been shown to reduce exacerbations in patients not receiving ICS (GOLD, 2019)

MUCOLYTIC & ANTIOXIDANT AGENTS

-Bronchodilators are given on a regular basis to patients with COPD to help reduce symptoms and improve airflow (GOLD, 2019)

-Both Short-acting bronchodilator (SABA) and Long-acting (LABA) are used in the daily management of patients

-They are also sometimes used in combination drugs with anticholinergic (SABA/SAMA) or (LABA/LAMA), or in a triple combination with the addition of ICS (LABA/LAMA/ICS)

BRONCHODILATORS

-Alpha 1 antitrypsin augmentation therapy -Antitussives -Vasodilators (GOLD, 2019)

OTHER PHARMOCOLOGIC THERAPY

PHARMACOLOGIC TREATMENT ALGORITHM

-Barriers most often include failed smoking cessation, noncompliance with medications, and comorbidities (Barros, 2020)

-Inhalers are often not used correctly and proper use should be assessed to ensure medication administration (Gold, 2019).

-Sometimes patients have adverse reactions to medications or do not believe they need them if they have no symptoms (Barros, 2020)

BARRIERS TO PRACTICE AND OTHER CONSIDERTAIONS:

Global Initiative for Chronic Obstructive Lung Disease (GOLD, 2019)

MOST RECENT GUIDLEINES

-Routine follow up is necessary as lung function can change over time (GOLD, 2019)

-There is no cure, only symptom management (Lopez, 2020)

-Treatment should be adjusted according to lung function and symptoms (Gold, 2019)

EXPECTED OUTCOMES

(GOLD, 2019)

References

Barros, R., Araújo, P., Mourato, C., Budzac, K.,

Oliveira, A. S., & Bárbara, C. (2020). Bronchodilator

reversibility: What are the differences between

asthma and chronic obstructive pulmonary disease?

Eurasian Journal of Pulmonology, 22(3), 169.

https://doi.org/10.4103/ejop.ejop_16_20

GOLD. (2019). Global strategy for the diagnosis,

management, and prevention of COPD. Retrieved

from https://goldcopd.org/wp-

content/uploads/2018/11/GOLD-2019-POCKET-

GUIDE-FINAL_WMS.pdf

Hollier, A. (2018). Clinical Guidelines in Primary

Care (3rd ed). Advanced Practice Education

Associates.

López, C., Mascarós, E., Azpeitia, A., & Villarrubia, E. (2020). A Simplified Algorithm for the Diagnosis, Treatment, and Management of COPD in Routine Primary Care Practice. International Journal of Chronic Obstructive Pulmonary Disease, Volume 15, 3347–3355. https://doi.org/10.2147/copd.s281422