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Simmons NURP 502 Exam 1 COPD Exacerbations

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This deck covers key concepts related to COPD exacerbations, including prognosis, treatment guidelines, symptoms, and management strategies based on the GOLD guidelines.

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Who has the worst prognosis?

• Over age 60 • FEV1<50%
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Key Terms

Term
Definition
Who has the worst prognosis?
• Over age 60 • FEV1<50%
GOLD guidelines recommend pharmacotherapy by _____.
GOLD guidelines recommend pharmacotherapy by severity.
When should ABX be prescribed in an exacerbation?
• 2 cardinal symptoms and 1 of them is increased purulence of sputum • Severe exacerbation requiring mechanical ventilation
According to GOLD guidelines, the below group should receive which ABX? Group B: Patients with moderate exacerbation and risk factor(s) for poor outcome.
β-lactam/β-lactamase inhibitor (e.g., Augmentin)
What constitutes an exacerbation?
Events in the natural course of the disease characterized by a change in the patient’s baseline dyspnea, cough, and/or sputum that: • Is beyond normal...
What are the 3 cardinal symptoms of an exacerbation?
1. Increased dyspnea 2. Increased sputum 3. Increased sputum purulence (including color change to green/yellow)
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Simmons NURP 502 Exam 1 COPD Exacerbations
TermDefinition
Who has the worst prognosis?
• Over age 60 • FEV1<50%
GOLD guidelines recommend pharmacotherapy by _____.
GOLD guidelines recommend pharmacotherapy by severity.
When should ABX be prescribed in an exacerbation?
• 2 cardinal symptoms and 1 of them is increased purulence of sputum • Severe exacerbation requiring mechanical ventilation
According to GOLD guidelines, the below group should receive which ABX? Group B: Patients with moderate exacerbation and risk factor(s) for poor outcome.
β-lactam/β-lactamase inhibitor (e.g., Augmentin)
What constitutes an exacerbation?
Events in the natural course of the disease characterized by a change in the patient’s baseline dyspnea, cough, and/or sputum that: • Is beyond normal day-to-day variations • Is acute in onset • May warrant a change in regular medication
What are the 3 cardinal symptoms of an exacerbation?
1. Increased dyspnea 2. Increased sputum 3. Increased sputum purulence (including color change to green/yellow)
How many days of oral steroids should be prescribed in an exacerbation?
• 5 day burst • 10 day taper

Which of these is not a best practice?

  • Use objective tests (spirometry, 6-minute walk) to confirm suspected diagnosis of COPD.

  • Apply the GOLD guideline recommendations for pharmacologic and nonpharmacologic management based on disease severity.

  • Partner with patients to review their at-home care setting, and consider individual’s needs, lifestyle, and preferences to maximize adherence to treatment regimens.

  • Consult with pulmonologist at initial diagnosis.

Comanage/consult with pulmonologist along the continuum of care.

What 2 things improve your prognosis?
1. Supplemental O2, when indicated 2. Smoking cessation
According to GOLD guidelines, the below group should receive which ABX? Group A: Patients with mild exacerbation and no risk factors for poor outcome.
1. β-lactam 2. Tetracycline 3. Bactrim
Your patient appears to be having an exacerbation. What measurements and diagnostics can help you?
1. CXR (r/o acute pneumonia, malignancy) 2. ABG (if hospitalized) 3. EKG 4. Oxygen Saturation
What 4 things weaken your prognosis?
1. Cor pulmonale 2. Hypercapnia 3. Tachycardia 4. Malnutrition
What is outpatient management for an exacerbation?
1. Bronchodilators 2. Oral steroids 3. Oxygen PRN 4. Antibiotics (maybe)
What are potential complications of an exacerbation?
1. Infections 2. Pneumothorax 3. Cor pulmonale 4. Secondary polycythemia 5. Bullous lung disease 6. Acute or chronic respiratory failure 7. Pulmonary hypertension 8. Malnutrition
_____ are central to the symptomatic and maintenance treatment of COPD.
Bronchodilators are central to the symptomatic and maintenance treatment of COPD.
What are the 3 keys to diagnosis of COPD?
1. Smoking hx 2. Physical exam 3. Spirometry
What are 4 common causes of exacerbations?
1. Acute infection (viruses, H. influenzae, M. catarrhalis, S. pneumoniae) 2. Congestive heart failure 3. Pulmonary embolism 4. Air pollution
How many days of bronchodilator should be prescribed in an exacerbation?
7 day minimum
According to GOLD guidelines, the below group should receive which ABX? Group C: Patients with severe exacerbations and risk for P. aeruginosa infection.
Fluoroquinolones
With 1 cardinal symptom of an exacerbation, what 5 things do you also assess for?
1. Upper respiratory infection (URI) in last 5 days 2. Fever without apparent cause 3. Increased wheezing, chest tightness 4. Increased cough 5. 20% increase in heart rate over baseline
Who has the best prognosis?
• Under age 60 • FEV1 >50%