CHRONIC
OBSTRUCTIVE
PULMONARY
DISEASE (COPD)
NR667: Bridget Aliff
COPD should be considered in any patient with
chronic cough, sputum production, and dyspnea
(GOLD, 2019). Spirometry is required for diagnosis
as it is the most objective measurement of airflow
limitation, a FEV1/FVC <70 post-bronchodilator
confirms diagnosis (GOLD, 2019).
CRITERIA FOR DIAGNOSIS
-Spirometry classification of airflow limitation
severity
-Modified MRC dyspnea scale
-CAT assessment
-The refined ABCD assessment tool
(GOLD, 2019)
COMMON DIAGNOSTICS
-Smoking cessation including electronic
cigarettes
-Supplemental oxygen
(Lopez et al., 2020)
-Both the Flu and pneumonia
vaccinations are recommended (Gold,
2019)
NON-
PHARMOCOLOGICAL
TREATMENT
COPD is a progressive condition that
causes pathological changes to the
airways (Hollier, 2018). The condition is
due to an exaggerated inflammatory
process that is caused by irritants or
pollutants and the inflammatory process
causes remodeling of the tissue which
overtime worsens symptoms (Hollier,
2018).
WHAT IS COPD?
PHARMACOLOGIC
TREATMENT
The goal of treatment of COPD is to reduce the
severity of symptoms, reduce the frequency of
exacerbations, and improve exercise tolerance.
There fore treatment plans are individualized
(GOLD, 2019)
Oral glucocorticoids are reserved for the
treatment of acute exacerbations due to the
systemic effects if used long-term (GOLD, 2019).
ORAL GLUCOCORTICOIDS
-The use of continuous prophylactic daily
antibiotics in patients with frequent
exacerbations has been shown to reduce the
incidence of exacerbations
(GOLD, 2019)
ANTIBIOTICS
Regular treatment with mucoltytics has
been shown to reduce exacerbations in
patients not receiving ICS (GOLD, 2019)
MUCOLYTIC &
ANTIOXIDANT AGENTS
-Bronchodilators are given on a regular basis
to patients with COPD to help reduce
symptoms and improve airflow (GOLD, 2019)
-Both Short-acting bronchodilator (SABA) and
Long-acting (LABA) are used in the daily
management of patients
-They are also sometimes used in combination
drugs with anticholinergic (SABA/SAMA) or
(LABA/LAMA), or in a triple combination with
the addition of ICS (LABA/LAMA/ICS)
BRONCHODILATORS
-Alpha 1 antitrypsin augmentation therapy
-Antitussives
-Vasodilators
(GOLD, 2019)
OTHER PHARMOCOLOGIC
THERAPY
PHARMACOLOGIC
TREATMENT
ALGORITHM
-Barriers most often include failed smoking
cessation, noncompliance with medications,
and comorbidities
(Barros, 2020)
-Inhalers are often not used correctly and
proper use should be assessed to ensure
medication administration (Gold, 2019).
-Sometimes patients have adverse reactions
to medications or do not believe they need
them if they have no symptoms (Barros,
2020)
BARRIERS TO PRACTICE
AND OTHER
CONSIDERTAIONS:
Global Initiative for Chronic Obstructive Lung
Disease (GOLD, 2019)
MOST RECENT GUIDLEINES
-Routine follow up is necessary as lung
function can change over time (GOLD,
2019)
-There is no cure, only symptom
management (Lopez, 2020)
-Treatment should be adjusted
according to lung function and
symptoms (Gold, 2019)
EXPECTED OUTCOMES
(GOLD, 2019)
References
Barros, R., Araújo, P., Mourato, C., Budzac, K.,
Oliveira, A. S., & Bárbara, C. (2020). Bronchodilator
reversibility: What are the differences between
asthma and chronic obstructive pulmonary disease?
Eurasian Journal of Pulmonology, 22(3), 169.
https://doi.org/10.4103/ejop.ejop_16_20
GOLD. (2019). Global strategy for the diagnosis,
management, and prevention of COPD. Retrieved
from https://goldcopd.org/wp-
content/uploads/2018/11/GOLD-2019-POCKET-
GUIDE-FINAL_WMS.pdf
Hollier, A. (2018). Clinical Guidelines in Primary
Care (3rd ed). Advanced Practice Education
Associates.
López, C., Mascarós, E., Azpeitia, A., & Villarrubia, E.
(2020). A Simplified Algorithm for the Diagnosis,
Treatment, and Management of COPD in Routine Primary
Care Practice. International Journal of Chronic
Obstructive Pulmonary Disease, Volume 15, 3347–3355.
https://doi.org/10.2147/copd.s281422
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