By rray, 22 February, 2024 Vaccinate COVID 19 according to nat l recs B Flu annually B Tdap if not previously received B Zoster if 50 yo B CDC recommends 1 dose of PCV20 or 1 dose of PCV15 followed by PPSV23 in pts w COPD B RSV vaccine A
By rray, 22 February, 2024 Smoking cessation A Prescribe 1 first line tx varenicline nortriptyline bupropion SR nicotine gum lozenge inhaler spray patch use drugs along w intervention program counsel1 at every visit No evidence to support use of e cigs as cessation aid
By rray, 22 February, 2024 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
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