APT: COPD
On October 18, we will be focusing on COPD for our Academic Half Day. In preparation there is a review article posted for pulmonary function tests. In addition, please review the GOLD Pocket guide. The guide itself is quite long, please focus on the diagnosis and management sections in the guide.
Indications for Noninvasive mechanical ventilation (at least one of the following)
Respiratory acidosis
Severe dyspnea with clinical signs suggestive of respiratory muscle fatigue, increased work of breathing, or both, accessory muscle use (paradoxical motion of abdomen, retraction of intercostal spaces)
Persistent hypoxemia despite supplemental oxygen therapy
SUMMARY
Classification of Airflow limitation severity in COPD
GOLD 1 (Mild): FEV1 ≥ 80% of predicted
GOLD 2 (Moderate): 50% ≤ FEV1 < 80%
GOLD 3 (Severe): 30% ≤ FEV1 < 50%
GOLD 4 (Very severe): FEV1 <30% of predicted
Triple therapy:
IMPACT Trial (Once-Daily Single-Inhaler Triple versus Dual Therapy in Patients with COPD (nejm.org) : phase 3 RCT that compared effects of once daily triple therapy with LABA+LAMA+ICS vs: LABA/ICS or LABA/LAMA on COPD exacerbation
in contrast to FLAME trial which showed a benefit of LAMA-LABA over ICS-LABA for prevention of exacerbations
triple therapy led to significantly lower rates of moderate or severe COPD exacerbations and better lung function and quality of life
Long term supplemental O2 therapy
indicated for stable patients who have SaO2 ≤ 88% or PaO2 ≤ 55mHg
also indicated if PaO2 between 55 and 60mmHg if also evidence of pulmonary hypertension, CHF, polycthemia (Hct > 55%)
NEJM LOTT trial (A Randomized Trial of Long-Term Oxygen for COPD with Moderate Desaturation | NEJM) - patients with stable COPD and resting or exercise induced moderate desaturation, the prescription of long term O2 did NOT result in longer time to death or 1st hospitalization than no long term O2.