CLINICAL MANAGEMENT GUIDELINE

Chronic obstructive lung disease

ICD10: Chronic obstructive pulmonary disease, unspecified [J44.9]

Treatment: Airway maintenance and symptoms reduction

It defined as an acute decline in respiratory functions manifested as severely worsening dyspnoea, cough and sputum production from the symptoms baseline. It triggered by an infection, airborne pollutants, and/or other factors (smoking).

Please follow Explicit criteria for hospital admission in exacerbations of chronic obstructive pulmonary disease.

Worsening chronic cough +/- sputum, Hx of long life smoking, dyspnea, tachypnea, lung wheezing, lower lobe crackles, hyper-resonance, +/- lung consolidation signs.

TestNoteSignificance
SpirometryDiagnostic: FEV1/FVC ratio <0.70, post bronchodilatorHigh sensitivity, High specificity
Chest radiologyTo excluded other pathology And to monitor for complications, i.e PnTXVariable sensitive, low specificity
Pulse oximetryFor monitoring.High sensitivity for blood oxygenation. Not specific for COPD
Blood gasesFor monitoring, if indicated.FEV1 <35%, pulse oximetry <92%,depressed level of consciousness or acute exacerbation of COPD
alpha-1 antitrypsinIf patient is < 45 y/o
Diffusing capacity for COFor monitoring the severity of emphysema.

Staging:

Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria: GOLD 1 - mild: FEV1≥ 80% predicted GOLD 2 - moderate: 50% ≤ FEV1 < 80% predicted GOLD 3 - severe: 30% ≤ FEV1 < 50% predicted GOLD 4 - very severe: FEV1 <30% predicted.


Maximize blood oxygenation. Reduce GOLD stage. Reduce the risk of COPD exacerbation. Reduce the risk of pneumonia. Reduce the risk of cardiac complications.

Monitoring parameters:

FEV1 every 1 year.

Pulse oximetry.

Clinical assessment.

Complications assessment.

Risks assessment.

Depression assessment.


How to use the levels:

Lvl 1 for:

Fewer manifestations and ≤1 exacerbation last year.

Lvl 2 for:

More manifestations and ≤1 exacerbation last year.

Lvl3 for:

Fewer manifestation and ≥2 exacerbations last year.

Lvl4 for:

More manifestation and ≥2 exacerbations last year.

Treatments

Level 1 / 4
pharmacological
Ipratropium
ROUTE
Inhalation/puff
DOSE
2.000 spray
FREQUENCY
QID PRN
pharmacological
Albuterol
ROUTE
Inhalation/puff
DOSE
1.000 spray
FREQUENCY
QID PRN
pharmacological
tiotropium
ROUTE
Inhalation
DOSE
18.000 Mcg
FREQUENCY
OD
pharmacological
salmeterol
ROUTE
Inhalation
DOSE
50.000 Mcg
FREQUENCY
BID
prevention
General outpatient clinic admission
prevention
Referral to smoking cessation advisor
consultation
Pulmonary rehabilitation
prevention
Influenza vaccination
prevention
Pneumococcal vaccination

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