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| (No se muestran 5 ediciones intermedias de 2 usuarios) |
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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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| 1. Albuterol
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| 2. Atrovent
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| 3. Steroids
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| Prednisone 40mg po qday x 5-10d
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| 4. Abx
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| Levaquin (sick)
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| Doxy (outpt) sputum change
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| 5. CXR
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| 6. BiPap/Intubation
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| 7. Carefull with O2 & hypoxic drive
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| ==Maintenance==
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| 1. 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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| 2. 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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| 3. 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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| 4. 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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| 5. 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]] | |
