COPD: Coughing Out Pretty Disgusting… things!
1. How do you diagnose COPD and what is the specific cut off that confirms the diagnosis?
2. How is COPD severity graded?
3. Name one change in pharmaceutical delivery method that can increase compliance in complex patients with COPD on multiple medications?
COPD is all too common in family practice so it shouldn’t surprise you if it showed up on the exam, and it’s often under-diagnosed. You don’t have to wait until the patient turns up in your office barrel-chested with prolonged expiration – by that point they have at least moderate COPD. So remember to offer pulmonary function tests (PFTs) to all your SOO patients in whom you suspect COPD.
1.COPD is diagnosed with PFTs/Spirometry. The specific cut off is a post-bronchodilator FEV1/FVC ≤ 0.70.
2.The grading of severity for COPD is a function of FEV1 (“Gold” criteria), with the important numbers being 30, 50, and 80. FEV1 >80 is mild, 50-80 is moderate, 30-50 is severe, and FEV1 <30 normal OR <50 normal WITH chronic respiratory failure present is very severe.
3.*New for 2016 guidelines: switch to OD inhalers. See great picture chart of inhalers at https://www.on.lung.ca/pcap-intranet/asthma-and-copd-medication-table
Once you get the diagnosis, you now think about treatment. It’s not only about puffers, though! You can always offer smoking cessation, exercise, respiratory therapy, preventative vaccines and more! The Review Course SNOPQRST mnemonic helps with that aspect of the exam for every SOO station!
In clinical practice, all the puffers can be confusing. Here is a useful table to look at, that I often pull up at an actual office visit to help the patient understand which puffers they need to take: https://www.on.lung.ca/pcap-intranet/asthma-and-copd-medication-table
For all stages, FEV1/FVC<0.70 (diagnostic for COPD), and:
Stage Severity FEV1 compared to normal
I Mild ≥ 80%
II Moderate 50-79%
III Severe 30-49%
IV Very Severe <30% , or <50% with chronic respiratory failure present*