By rray, 22 February, 2024 Patient Type Header (Long) GOLD group E. Any mMRC or CAT score w/ ≥2 mod/severe exac/yr or ≥1 COPD hospitalization in past yr. Does this Patient Type contain sub types? No Patient Type Details Give long acting inhaled BD combo LABA LAMA plus short acting rescue BD inhaled is preferred vs oral A Add ICS if blood eos 300 LABA ICS not recommended LABAs and LAMAs improve dyspnea reduce exac rate A LAMAs reduce exac A and hospitalizations B more tha Offer pulmonary rehab A Encourage physical activity improves SOB health status exercise tolerance in stable COPD A reduces hospitalization in pts w recent exac B Optimum benefits seen from 6 to 8 wk program no evidence supports 12wk Twice weekly supervise If hypoxemic per SpO2 ABG Assess for long term O2 tx indications SpO2 88 or PaO2 55 mmHg w or w o hypercapnia 2x in 3wk or sat 88 or PaO2 55 60 mmHg w pulm HTN edema suggesting CHF or hct 55 Prescribe O2 for severe resting hypoxemia A If stable w marked hypercapnia consider NPPV NPPV may improve hospital free survival in select pts post recent hospitalization esp if daytime PaCO2 53 mmHg B Long term NPPV beneficial in pts w severe chronic hypercapnia and hx of hospitalization for acute If severe dz emphysema w hyperinflation consider procedural interventions After tx initiation review assess and adjust if needed Review sx and exac risk hx and blood eos Assess inhaler technique and benefits of non pharm tx e g pulm rehab self mgmt education at every visit If benefit is documented continue otherwise stop or try Mitigate risks Treatments w no or uncertain benefits oral steroids C antitussives C vasodilators B drugs for primary pulm HTN B mepolizumab benralizumab dupilumab nedocromil leukotriene modifiers infliximab immunostimulants beta blockers if no CV indication for use simv
