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 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
By rray, 22 February, 2024 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
By rray, 22 February, 2024 LABA LAMA nbsp nbsp LABA options arformoterol formoterol olodaterol salmeterol nbsp nbsp LAMA options aclidinium glycopyrrolate revefenacin tiotropium DPI MDI umeclidinium nbsp nbsp LAMA LABA combo options aclidinium formoterol glycopyrrolate formoterol t
By rray, 22 February, 2024 Rescue short acting BD SABA or SAMA for immediate sx relief SABA options albuterol levalbuterol MDI NEB SAMA ipratropium MDI NEB