By rray, 22 February, 2024 Patient Type Header (Long) Any GOLD group w/ exacerbations (+/- dyspnea) Does this Patient Type contain sub types? No Patient Type Details Check adherence inhaler technique and possible interfering comorbidities Target exac dyspnea w additional tx Mitigate risks If advanced COPD consider palliative care and end of life support Consider 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 superv 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 Consider palliative approaches for all pts w sx D
