By rray, 22 February, 2024 If AATD alpha 1 antitrypsin IV augmentation may slow emphysema progression B
By rray, 22 February, 2024 If progressive COPD noncandidate for endoscopic surgical LVRS w BODE Index 5 6 PCO2 50 mmHg and or PaO2
By rray, 22 February, 2024 If no large bulla consider ELVR or LVRS in select pts nbsp nbsp LVRS improves survival in severe dz w upper lobe emphysema low post rehab exercise capacity A however LVRS shows higher mortality vs medical mgmt in pts w FEV1 20 predicted w either homogeneo
By rray, 22 February, 2024 If giant bulla consider bullectomy in select pts C assoc w decr dyspnea improved lung fxn and exercise tolerance
By rray, 22 February, 2024 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
By rray, 22 February, 2024 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
By rray, 22 February, 2024 Air travel If resting sat 95 w 6 min walk sat 84 air travel OK however severe hypoxemia in air travel may occur despite sea level sat C
By rray, 22 February, 2024 If placed on long term O2 titrate to keep sat 90 re evaluate at 60 90 days w pulse ox ABG
By rray, 22 February, 2024 If stable COPD w only moderate resting exercise induced desaturation no benefit to O2 A
By rray, 22 February, 2024 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