Applying Standards of Care to Conditions: COPD

Now let’s talk about COPD. Standards of Care for COPD are divided into several categories including diagnosis, assessment, and management.

 

Diagnosis Assessment Management

 

There are many recommendations regarding the prevention, diagnosis, and assessment of COPD. Those recommendations with a “strong for” recommendation grade include:

-The guidelines recommend offering prevention activities including smoking cessation and risk reduction efforts such as vaccinations.

-The use of spirometry to demonstrate airflow obstruction to confirm all initial diagnoses of COPD.

 

Regarding assessment of comorbidities:

-The guidelines recommend investigating additional comorbid diagnoses in patients who experience frequent exacerbations (two or more/year), having one of more of the following: a prescription of corticosteroids or antibiotics, hospitalization, or emergency room visit using simple tests and decision rules (cardiac ischemia [troponin, electrocardiogram], congestive heart failure [B-type natriuretic peptide (BNP), pro-BNP], pulmonary embolism [D-dimer plus clinical decision rule], and gastroesophageal reflux).

-The guideline panel recommends that patients with AAT deficiency be referred to a pulmonologist for management of their treatment.

 

Management      Prevention and risk reduction      Medications: according to stability, dyspnea, pain relief      Therapies: oxygen therapy, pulmonary rehabilitation      Transplant

 

Regarding the use of oxygen therapy in this population:

-The guideline panel recommends providing long-term oxygen therapy (LTOT) to patients with chronic stable resting severe hypoxemia, or chronic stable resting moderate hypoxemia, with signs of tissue hypoxia.

-The guideline panel recommends that patients discharged home from hospitalization with acute transitional oxygen therapy are evaluated for the need for LTOT within 30-90 days after discharge. The guidelines also state that LTOT should not be discontinued if patients continue to meet the above criteria.

 

Regarding the use of pulmonary rehab in this population:

-The guidelines recommend offering pulmonary rehabilitation to stable patients with exercise limitations despite pharmacologic treatment, and to patients who have recently been hospitalized for an acute exacerbation.

 

Regarding the use of Lung Volume Reduction Surgery (LVRS) and Lung Transplant:

-The guidelines recommend that any patient considered for surgery for COPD first be referred to a pulmonologist.

And there are guidelines for the management of patients in acute exacerbation:

-They recommend antibiotic use for patients with COPD exacerbations who have increased dyspnea and increased sputum.

For patients with acute COPD exacerbations, the guideline panel recommends a course of systemic corticosteroids of 30-40 mg (prednisone or equivalent) for 5-7 days.

 

Management of Patients with COPD in the Hospital or Emergency Department:

-The guideline panel recommends the early use of non-invasive ventilation (NIV) in patients with acute COPD exacerbations to reduce intubation, mortality, and length of hospital stay.

-The guidelines also recommend the use of NIV to support weaning from invasive mechanical ventilation, and earlier extubation of intubated patients with COPD.