In this post I link to and excerpt from #86: COPD: Diagnosis, treatment, PFTs, and nihilism. [Link is to the podcast and show notes.]
MARCH 12, 2018 By LEAH WITT MD
Here is the podcast embedded:
And here are excerpts:
- Key indicators for COPD diagnosis include: dyspnea, chronic cough, chronic sputum production, recurrent lower respiratory tract infections, and smoke exposure in patient >40 yo (GOLD guidelines COPD 2017). Tobacco use is a key part of the history. Spirometry is confirmatory testing (NOT diagnostic in and of itself!).
- Supplemental oxygen and tobacco cessation reduce mortality in COPD.
- Smokers can be hypoxic despite normal resting O2 saturation because pulse oximeter cannot tell the difference between oxy- and carboxyhemoglobin. Check an ABG to determine pO2 and need for oxygen therapy.
- Inhalers for COPD improve symptoms and exacerbations, NOT mortality. Patients w/o symptoms and exacerbations can get by w/albuterol as needed.
- Consider azithromycin or roflumilast in patients with moderate/severe COPD (despite inhaler use) with the goal of decreasing exacerbation frequency.
- The only thing you should NOT do in COPD is inhaled corticosteroids as monotherapy. -Dr Blagev
- The only thing you should NOT do in Asthma long acting beta agonist monotherapy. -Dr Blagev
- A significant change between pre- and post-bronchodilator spirometry suggests how much room for improvement exists with the addition of inhaled therapies. Once controlled, a significant post-bronchodilator response may be absent on subsequent spirometry.
- Spirometry values are no longer at the center of how we stage/assess COPD. It is much more important to assess/manage other contributing factors like dysphagia, heart failure, and need for CPAP or BIPAP in order to prevent symptoms and exacerbations.
The complete show notes contain additional details and are well worth reviewing.