FEV1 Greater than or equal to 80% predicted
Gold 1: Mild COPD
50% less than or equal to FEV1 Less than 80% predicted
Gold 2: Moderate
... [Show More] COPD
30% less than or equal to FEV1 Less than 50% predicted
Gold 3: Severe COPD
FEV1 Less than 30% predicted
Gold 4: Very severe COPD
What gold guidelines suggest following meds for COPD
Long acting bronchodilators (LABA) A long acting muscarinic antagonist (LAMA) or both
Inhaled corticosteroids (ICS) Although not for monotherapy (with ICS plus a LABA For step up therapy
An oral PDE4 Inhibitor as an add-on therapy for patients with COPD plus chronic bronchitis, if previously recommended medicines are in effective or in adequate
Gold guidelines suggest using these medications according to the following grading scheme of clinical severity
Grade A: any short or long acting bronchodilator
Grade B: A long-acting bronchodilator(LAMA or LABA) or both, if continued difficulty breathing with only one drug
Grade C: A long acting muscarinic antagonist (LAMA) Or if continued exacerbations occur, A switch to LAMA+LABA or LABA+ICS
Grade D: individualized management, possibly using a PDE4 Inhibitor, Roflumilast (Daliresp) and azithromycin (Zithromax); antibiotics are warranted in the presence of a prolonged illness, especially with purulent sputum
Management of COPD exacerbations
Treatment modalities Include short acting beta two agonist's with or without anti-cholinergics, long acting bronchodilators, systemic corticosteroids, antibiotics, non-invasive mechanical ventilation, and or invasive mechanical ventilation
Classification of asthma severity
Intermittent, MildPersistent, Moderate persistent, severe persistent
Intermittent asthma severity
Symptoms less then two days per week
Nighttime symptoms less than twice per month
Asymptomatic and normal peak expiratory flow between exacerbations
PEF or forced expiratory volume in one second (FEV1) Less than 80% predicted, PFT variability greater than 20%
Mild persistent asthma
Symptoms occur >2x/wk, but not daily
May occur Several times at night per month
PEF or FEV1 Greater than 80% predicted, PFT variability 20% to 30%
Moderate persistent asthma
Step 3: low dose ICS + LABA (Salmeterol)
Daily symptoms but not continual, nighttime symptoms more than once a week, but not nightly
Exacerbations affect activity and sleep
PEF or FEV1 less than 60% to 80% predicted, PFT Variability less than 30%
Severe persistent asthma
Continuous daily symptoms
Frequent nighttime symptoms
Physical activity is limited by asthma
Frequent exacerbations
PEF or FEV1 Less than 60% predicted, variability greater than 30%
Diagnostics for asthma
Spirometry or pulmonary function testing, particularly forced expiratory volume in one second (FEV1), FEV6, forced final capacity (FVC), and FEV1/FVC ratio before and after bronchodilator challenge, showing an improvement of 12% and 200 ML, indicates reversible airway obstruction
Intermittent asthma step one treatment
SABA PRN less than twice per week
Persistent asthma mild persistent step 2 Treatment
SABA PRN, not to exceed 3 to 4 times per day
Preferred daily medications low-dose ICS
Alternative daily medications Leukotriene receptor agonist, Cromolyn, Nedocromil, or theophylline
Moderate persistent asthma step three
SABA PRN, not to exceed 3 to 4 times per day
Preferred daily medications: Low dose ICS Plus LABA Or Medium dose ICS
Alternative daily medications: low-dose ICS Plus either leukotriene receptor agonist, theophylline, zileuton
Severe persistent asthma step four treatment
SABA PRN, not to exceed 3 to 4 times per day consider short course of oral systemic corticosteroids
Preferred daily medications
Medium-dose ICS plus LABA
Alternative daily medications
Medium-dose ICS plus either Leukotriene receptor agonist, theophylline, or Zileuton
Asthma step five Treatment
SABA inhale treatments at 20 minute intervals times three if needed consider short course of oral systemic corticosteroids
Prefer daily medications
High-dose ICS plus LABA
Alternative daily medications
Consider omalizumab for patients who have allergies [Show Less]