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| ==Definition==
| | #REDIRECT[[COPD exacerbation]] |
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| Airflow obstruction as measured by spirometry isdefined as a ratio of the postbronchodilator FEV1 : FVC < 0.70
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| ==Exacerbation==
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| #Albuterol | |
| #Atrovent
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| #Steroids: Prednisone 40mg po qday x 5-10d
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| #Abx
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| #*Levaquin (sick)
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| #*Doxy (outpt) sputum change
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| #CXR
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| #BiPap/Intubation
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| #Carefull with O2 & hypoxic drive
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| ==Maintenance==
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| #B-agonist
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| #*Short: albuterol 90µg/inh 1-2 q4-6h prn; neb 2.5mg q4-6h prn
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| #*Long: Salmeterol 50µg/inh 1 bid
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| #*Formoterol MDI 12µg/INH 1 bid; neb 20µg bid
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| #*Arfomoterol neb 15µg bid
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| #Anticholinergic
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| #*Short: ipratriopium 17µg/INH 2xINH 4x/d up to 12; neb 0.5mg q6-8h
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| #*Long: tiotropium 18µg/INH 1xINH qam
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| #Steroids (inhaled)
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| #*Fluticasone (dry powder) 250µg/INH 1-2 bid; (aerosol) 220µg 1-2INH bid
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| #*Budesonide 160µk 2 inh bid
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| #*Beclomethasone 80µg/inh 2INH bid
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| #*Mometasone 220µg/INH 1-2INH bid
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| #Combination
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| #*Albuterol-Ipratropium 90/18 2INH 4xd up to 12
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| #*Advair Diskus = Fluticasone-salmeterol (dry powder): 250/50 1INH bid
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| #*Budesonide-Formoterol: 160/4.5 2INH bid
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| #Home O2
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| #*Indicated if PaO2 < 55mmHg or O2 Sat < 88% RA
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| Goal is 18h/day including sleep with flow rate that maintain sat > 90%
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| ==Source==
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| DONALDSON 1/06, NEJM 4/10
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| [[Category:Pulm]] | |
