Management of Chronic Stable COPD - PowerPoint Presentation

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Management of Chronic Stable COPD *Based on GOLD Risk Stratification 2019CategorySymptomsRiskSuggested TreatmentCo- ManagementALL PatientsShort-acting Bronchodilator (rescue)Self-Management EducationSmoking cessationIncrease Exercise toleranceInfluenza and Pneumococcal vaccinationALess symptomaticMild or infrequent symptoms, breathless with strenuous exercise or when hurrying on level ground or walking up a slight hillLow RiskmMRC 0-1 or CAT <10, AND0 to 1 exacerbations a year not leading to hospital admissionPharmacologic: First choice: LAMA or LABAPrimary CareBMore symptomatic:Moderate to sever symptoms (i.e. Patient has to walk more slowly that others of the same age due to breathlessness, has to stop to catch breath when walking on level ground)Low RiskmMRC 0-1 or CAT <10, AND0 to 1 exacerbations a year not leading to hospital admissionPharmacologicFirst choice: LAMA or LABA Second Choice: LABA/ICS combination in patients eos ≥ 300 or eos ≥100 AND ≥ 2 moderate exacerbations/ 1 hospitalizationNon-Pharmacologic: Pulmonary RehabPrimary CareCLess symptomaticMild or infrequent symptoms, breathless with strenuous exercise or when hurrying on level ground or walking up a slight hillHigh RiskmMRC ≥ 0-1 or CAT ≥ 10, AND≥ 2 exacerbations a year OR ≥ 1 leading to hospitalizationPharmacologicFirst choice: LAMA Non-Pharmacologic: Pulmonary RehabPrimary CareConsider Referral to Pulmonary Medicine for Co-ManagementDMore symptomatic:Moderate to sever symptoms (i.e. Patient has to walk more slowly that others of the same age due to breathlessness, has to stop to catch breath when walking on level ground)High RiskmMRC ≥ 0-1 or CAT ≥ 10, AND≥ 2 exacerbations a year OR ≥ 1 leading to hospitalizationPharmacologicFirst choice: LAMA: Initial therapyLAMA/LABA: Preferred if highly symptomatic (i.e. CAT >20)LABA/ICS: Preferred if eos ≥300 Second choice: LAMA/LABA/ICS: Preferred as escalation of therapy if eos ≥ 100 with predominant exacerbations OR if dyspnea is not controlled by LABA/ICSNon-Pharmacologic: Pulmonary RehabPrimary Care Referral to Pulmonary Medicine for Co- ManagementPalliative care referral for COPD Patients with more than 1 hospitalization a year for COPD Exacerbation

Hospital Follow Up for Acute Exacerbation of COPDPhone Call within 24 hours of DischargeOffice Visit within 3- 7 days with PCPRefer to Pulmonary if meets criteriaArrange for Pulmonary follow up, if established patientRefer to Palliative Care, per criteria belowHospital Follow Up and Referral Pathways for COPDReferral PathwaysPulmonary to Consult and Co- Manage: Severe COPD, GOLD Stage DPulmonary to Consult and Co- Manage: If 2 or more admissions per year for AE-COPDPalliative care consult: If ≥ 1 hospitalizations per year for COPD