Chronic Obstructive Pulmonary Disease

Abstract

HOSPITAL MEDICINE CLINICS CHECKLIST1. Acute exacerbations of chronic obstructive pulmonary disease (COPD) are common in the course of chronic COPD, and are associated with substantial morbidity. 2. There are numerous guidelines, but literature suggests that there is substantial variation in care in patients with acute exacerbations of COPD. 3. Key components of acute therapy for most patients include oral steroids, antibiotics, nebulizers, oxygen, and early consideration of noninvasive ventilation. 4. Adjuvant components of care include venous thromboembolism prophylaxis, appropriate immunizations, counseling for smoking cessation, and consideration of pulmonary rehabilitation. DEFINITIONS AND BURDEN OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE AND EXACERBATIONSHow is chronic obstructive pulmonary disease defined and diagnosed?Chronic obstructive pulmonary disease (COPD) is an acquired and progressive pulmonary disorder. The principal physiologic lesion is airflow limitation, demonstrated on pulmonary function testing. Pathophysiologically, COPD is marked by evidence of chronic airway inflammation, loss of airway elasticity, and destruction of the alveoli. COPD develops over years of exposure to noxious substances. At least 80% of the overall risk is considered attributable to smoking and exposure to smoking. Air pollution and other environmental agents may cause or contribute to COPD, in addition to unusual inherited disorders such as a1-antitrypsin deficiency.

An overview of noninvasive ventilation in cystic fibrosis

“…Traditionally, in an in-patient setting, NIV is adjusted to target work of breathing, pH or PaCO 2 . 71 For patients with hypercapnic COPD, the ATS recommends normalization of awake arterial CO 2 tension. 70 While similar treatment goals have not been established in hypercapnic CF, it is recommended that NIV be initiated for elevated CO 2 tension.…”

An Overview of Noninvasive Ventilation in Cystic Fibrosis

“…Traditionally, in an in-patient setting, NIV is adjusted to target work of breathing, pH or paCO 2 . 77 For patients with hypercapnic COPD, the American Thoracic Society recommends normalization of awake arterial CO 2 tension. 78 While similar treatment goals have not been established in hypercapnic CF, it is recommended that NIV be initiated for elevated CO 2 tension.…”

“…39 Establishing a goal of reducing awake paCO 2 to approach eucapnia may be a reasonable goal. 77 In addition to evaluation of arterial blood gases, review of data from NIV may be helpful to determine if treatment targets are met. Common targets in NIV learned from other disease states are ensuring that sufficient tidal volumes are being delivered, and that there is sufficient ventilatory rest.…”

“…In some patients, NIV can worsen work of breathing and these patients must be identified rapidly in order to seek guidance from sleep boarded physicians 77 . It is important that CF providers review any downloads that cause concern with an expert in this field.…”