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Old 05-14-2012
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Lungs COPD step-wise Management Options

What are the management options in COPD from initial to last resort (its confusing every book mention different thing)
in mtb2 albuterol --> anticholin --> ICS
in old kaplan anticholie are first line

the rx option are SABA, Anticholine, ICS, LABA & pulmonary rehab , Surgery (vol reduction & transplant)

is this suppose to be the order
bronchodilator (SABA/Anticholin) --> LABA or longacting anticholin (tiopropium) --> together ---> ICS trial, if improvement occur continue and if not stop --> Surgery

and is Vol reduction surgery lower mortality ? or no (somesay in certain pt, who r they ?)

another Question
best indicator for the severity of asthma is RR
what is the best indicator for COPD >> is it PaCO2 level

Last edited by bisho; 05-14-2012 at 11:56 PM.
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Old 05-15-2012
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the thing in MTB is correct generally cos MTB is updated every year. kaplan notes will be updated and new edition with changes will be out by the end of this year.

anyway about COPD

SABA is the 1st Rx in both acute and chronic.

http://emedicine.medscape.com/articl...#aw2aab6b6b1aa

however most COPD patients wud eventually need SABA+anti cholinergic. for both acute and chronic managment



indicator of severity wud be PO2/SiO2 levels rather than PCO2 levels.
cos the PO2/SiO2 levels indicate when we wud put a patient on home oxygen therapy, which is the only thing that lowers mortality.
so i think it wud be that
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Old 05-15-2012
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indicator of severity wud be PO2/SiO2 levels rather than PCO2 levels.
cos the PO2/SiO2 levels indicate when we wud put a patient on home oxygen therapy, which is the only thing that lowers mortality.
so i think it wud be that

ididn't get what u mean by PO2/SiO2 (is this a ration or just either one),and do u mean by SiO2 = O2 saturation in arterial blood

SO even in ACUTE exacerbation this would be apply,
cuz we look at co2 level to predict impending respiratory failure, though in COPD pt retain co2 outside attack ??
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Old 05-15-2012
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Quote:
Originally Posted by bisho View Post

ididn't get what u mean by PO2/SiO2 (is this a ration or just either one),and do u mean by SiO2 = O2 saturation in arterial blood

SO even in ACUTE exacerbation this would be apply,
cuz we look at co2 level to predict impending respiratory failure, though in COPD pt retain co2 outside attack ??
i meant
EITHER PO2 OR SiO2 LEVELS..

ie.. partial pressure of O2 or oxygen saturation

check page 136 MTB2
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Old 05-15-2012
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I think it depends on how they ask the question...

Patients with COPD have cholinergic hyperactivity so theoretically a antimuscarinic is better. It also lowers mortality and hospitalizations in these patients. All of this because it slows down the loss of pulmonary function.

A B-agonist works better during a crisis because it causes immediate bronchodilation and an anti-M (such as tiotropium) takes about 30 minutes.

So if it's acute I would put a B-agonist but I would answer anti-M if they ask about improving overall condition in the long run.

My 0.02
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i think they wont ask which one of bronchodilator is first
cuz u r going to give them together anyway

but the question is outside acute exacerbation
SABA-->Ipra-->ICS (mtb2)
or SABA/ipra -->Tio/LABA --> ICS (emedicine)
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Quote:
Originally Posted by bisho View Post
i think they wont ask which one of bronchodilator is first
cuz u r going to give them together anyway

but the question is outside acute exacerbation
SABA-->Ipra-->ICS (mtb2)
or SABA/ipra -->Tio/LABA --> ICS (emedicine)
SABA/Ipra --->Tio/LABA ----> ICS

Knowing that Tio is super important for the disease than a SABA is what I meant to point out. SABA just bronchodilates in the moment. Tio improves natural progression of the disease.
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Old 05-16-2012
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It was discussed here earlier
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