GOLD-Criteria.ppt

Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Caring for Patients with COPD:Guidelines for Diagnosis and Management,M.Elizabeth Knauft,MD MS,September 20,2007,GOLD,Diagnosis and Classification of COPD,4 major components of COPD management,Assess and Monitor Disease,Reduce Risk Factors,Manage Stable COPD,Manage Exacerbations,GOLD,1998:Global Initiative for Chronic Obstructive Lung Disease,2001:,Global Strategy for the Diagnosis,Management,and Prevention of COPD,2006:Revision of above,Goals of GOLD,“To improve prevention and management of COPD through a concerted worldwide effort of people involved in all facets of healthcare and healthcare policy,and to encourage an expanded level of research interest in this highly prevalent disease.”,Definition of COPD,Preventable and treatable disease with some significant extrapulmonary effects that may contribute to the severity in individual patients,Pulmonary component characterized by airflow limitation that is not fully reversible.,Airflow limitation progressive and associated with abnormal inflammatory response of the lung to noxious particles or gases,Spirometric Classification of COPD Severity Based on Post-Bronchodilator FEV1,Stage I:,Mild,FEV1/FVC 80%predicted,Stage II:,Moderate,FEV1/FVC 70%;50%FEV180%pred.,Stage III:Severe,FEV1/FVC 70%;30%FEV150%pred.,Stage IV:,Very Severe,FEV1/FVC 70%,FEV130%,or FEV1 50%pred.plus presence of chronic respiratory failure,Case ContSpirometry,FEV1/FVC:0.50,Postbronchodilator FEV1:1.23L(63%predicted),Mechanism of COPD,Proximal and peripheral airways,lung parenchyma,pulmonary vasculature affected,Chronic inflammatory changes,amplified by oxidative stress,Burden of COPD,Prevalence higher in,smokers and ex-smokers than nonsmokers,Patients over 40 than those under 40,Men than in women,Morbidity,Mortality,6,th,leading cause of death in 1990(Global Burden on Disease Study),Projected to be 3,rd,leading cause by 2020,Management Goals for COPD,Relieve symptoms,Prevent progression of disease,Improve exercise tolerance,Improve health status,Prevent and treat complications,Prevent and treat exacerbations,Reduce mortality,Assess and Monitor Disease,Dyspnea,Progressive,persistent,worse with exercise,“increased effort to breathe”,“air hunger”,Chronic cough,Intermittent,non-productive,Chronic sputum production,Any pattern,History of exposure to risk factors,Tobacco,occupational dust/chemicals,home cooking,heating fuels,Assess and Monitor Disease-2,Confirm diagnosis by spirometry,Post bronchodilator FEV1/FVC 0.70,Obtain ABG if FEV1 50%predicted or clinical signs right heart failure,Alpha-1 antitrypsin level in young pts(45 years),Identify comorbidities,Reduce Risk Factors,Smoking Cessation!,Reduction of indoor and outdoor air pollution,Manage Stable COPD,Individualize overall approach to address symptoms and improve quality of life,Smoking cessation,Pharmacotherapy for COPD used to decrease symptoms and/or complications,do NOT modify long-term decline in lung function,Manage Stable COPD-2Bronchodilators,B-2 agonists,anticholinergics,methylxanthines,Symptomatic management:prn or scheduled,Increase exercise capacity,Do not necessarily improve FEV1,LABA more effective than SABA,Combination therapy more effective than increasing dose of single agent,Long acting anticholinergic reduces rate of COPD exacerbations,improves effectiveness of pulmonary rehabilitation,Manage Stable COPD-3Glucocorticosteroids,Inhaled corticosteroids(ICS)do not modify long term decline in FEV1,ICS appropriate for symptomatic,FEV1 65years;65 years with FEV1 15 h/day improves survival in patients with chronic respiratory failure,PaO255,SaO2 55%),Therapy at Each Stage of COPD,Stage I:,Mild,Reduction of risk factors;influenza vaccination,Add short-acting bronchodilators prn,Stage II:,Moderate,Add regular treatment with one or more long-acting bronchodilators;add rehabilitation,Stage III:,Severe,Add inhaled glucocorticosteroids if repeated exacerbations,Stage IV:,Very Severe,Add long-term oxygen if chronic respiratory failure;consider surgical treatments,Case Cont,Short acting B2 agonist,Long acting bronchodilator(B2 agonist or anticholinergic),Influenza vaccine,Pneumococcal vaccine,Smoking cessation,Manage Exacerbations,Increased SOB,wheeze,chest tightness,increased cough and sputum,change in color or tenacity of sputum,Assess severity,Dependent on pts baseline prior to exacerbation,ABG,FEV1 not practical,CXR,Sputum culture,Manage ExacerbationsHome management,Increase dose and/or frequency of short acting bronchodilator therapy,Consider adding anticholinergic agent,Systemic glucocorticosteroids,Shorten recovery time,Improve FEV1 and hypoxemia,Consider(in addition to bronchodilators)if FEV1 25 bpm),Manage ExacerbationsDischarge Criteria,Inhaled B2 agonist therapy is required no more than every 4 hours,Pt able to walk across room(if previously ambulatory),Clinically stable for 12-24 h,Stable ABG for 12-24 h,Patient/caregiver understands proper medication use,Home care/follow-up arrangements made,Summary,Diagnosis of COPD requires post-bronchodilator FEV1,Tobacco cessation,Layer treatment according to stage of COPD,