86. Every Breath You Take - Long Term Management of COPD
May 2, 2021
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Exploration of COPD management strategies, inhalers and their benefits, inhaled corticosteroid therapy, long-term treatment options including lung transplants and palliative care. Insights on lung transplant eligibility, palliative care significance, and type A personality's link to smoking and heart disease.
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Quick takeaways
Diagnosing COPD involves spirometry to determine airflow obstruction, with FEV1 to FEC ratio less than 0.7 post-bronchodilator indicating the disease.
Effective COPD management includes smoking cessation, vaccinations, inhalers, and other therapies to reduce mortality and alleviate symptoms.
Deep dives
Understanding COPD: Disease Progression and Pathophysiology
COPD is a progressive lung disease resulting from damage to the airways and alveoli, primarily caused by smoking or other inhaled irritants. The disease includes chronic bronchitis characterized by mucous gland hyperplasia and emphysema featuring alveolar damage. COPD patients experience constricted airways and decreased lung compliance, leading to hyperinflation and difficulty exhaling completely. The disease's complexity lies in the irreversible airflow obstruction and the various pathological changes in the airways and lung tissue.
Diagnostic Tools and Disease Severity Classification
Diagnosing COPD involves spirometry, with an FEV1 to FEC ratio less than 0.7 post-bronchodilator indicating the disease. Severity classification relies on the patient's FEV1 post-bronchodilator, categorizing individuals as mild, moderate, severe, or very severe based on the lung function. Additional tools like exacerbation history and dyspnea assessment aid in prognosis using the GOLD ABCD criteria and COP Assessment Test (CAT) score. The diagnosis process guides therapeutic decisions and long-term management strategies for COPD patients.
Comprehensive COPD Management Approaches
Effective COPD management strategies aim to reduce mortality, alleviate symptoms, and prevent exacerbations. Smoking cessation is crucial for survival as it slows disease progression significantly. Vaccinations, including flu shots and pneumococcus vaccines, help prevent exacerbations. Inhalers play a key role in symptom management, while other therapies like azithromycin and pulmonary rehabilitation further enhance treatment outcomes. Severe cases may require home oxygen therapy or, in rare instances, surgical interventions like lung reduction or lung transplantation. Palliative care becomes essential for patients in advanced stages of the disease, emphasizing symptom management and quality of life.
In this episode, we'll discuss how to manage patients with chronic COPD. We'll go through a large variety of interventions and highlight which interventions have a symptomatic benefit and which interventions have a mortality benefit. Our guidelines are based on the GOLD COPD guidelines. Check out our associated infographic at www.theinternatwork.com.
Written by: Dr. Shayan Kassirian (Internal Medicine Resident) Reviewed by: Dr. Cory Yamashita (Respirology) and Dr. Jeffrey You (General Internal Medicine)