Chronic COPD. Ambulatory Subacute Treatment.

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Source: Texas Tech University Managed Health Care Network Pharmacy & Therapeutics Committee. Chronic COPD. University of Texas Medical Branch Correctional Managed Care; 2003 Apr. 7 p. Chronic COPD. Ambulatory Subacute Treatment. Moderate (Stage 1). Mild, variable symptoms (FEV1 greater than 30% Predicted). 1. Complete Spirometry. 2. Daily symptoms? Severe (Stage 2 or 3). Mild to Moderate symptoms (FEV1 less than 30% Predicted). ß2 Selective Agonist Inhaler- Albuterol 2 puffs PRN up to QID. Duration of inhaler (30-90 days) determined by patient use. Patient Education Proper use of inhaler (see Patient Education Box, page 3). Patient Stable? ß2 Selective Agonist Inhaler- Albuterol 2 puffs PRN up to QID. Duration of inhaler (30-90 days) determined by patient use. And Anticholinergic inhaler Ipratropium Bromide 2 puffs QID. 1 inhaler to last 30 days. Patient Education. Proper use of inhaler and importance of scheduled dosing with Ipratropium (not effective PRN). (see Patient Education Box, page 3) Continue regimen. Follow-up every 3 months with Peak Flow and spirometry every 1-2 years. Patient Stable? The pathways do not replace sound clinical judgement nor are they intended to strictly apply to all patients Patient Stable? Increase Ipratropium Dosage, 4 puffs QID, 1 inhaler supplies approximately 14 days therapy at this dosage. Continue ß2 Agonist Inhaler- 2 puffs QID PRN, 1 inhaler to last 30-60 days dependent upon patient needs. Patient Education. Reinforce proper use of inhaler and importance of scheduled dosing of Ipratropium. (see Patient Education Box, page 3) Increase Ipratropium Dosage, 6 puffs QID. 1 inhaler supplies approximately 7 days therapy at this dosage. And Consider Scheduled dosage of ß2 Agonist Inhaler- 2 puffs QID, 1 inhaler to last 30 days. Patient Education. Reinforce proper use of inhaler and importance of scheduled dosing of Ipratropium. (See Patient Education Box, page 3) Patient Stable? Continue regimen. Follow-up every 3 months with Peak Flow and spirometry every 1-2 years. Add Oral Corticosteroid- Prednisone 20mg-40mg Q day x 14 days. Stop oral Corticosteroid, Add Inhaled Corticosteroid- Triamcinolone 2 puffs BID. Patient Teaching. Inhaler use counseling, emphasize importance of scheduled dosing for corticosteroid/anticholinergic inhalers. These agents are ineffective as PRN therapy. (see Patient Education page 3) Patient Stable? Stop Oral Corticosteroid- Consider referral to a specialist Patient Stable? Continue regimen. Follow-up every 3 months with peak flow and spirometry every 1-2 years. Increased Inhaled Corticosteroid- Triamcinolone 2 puffs TID. 1 inhaler will supply approximately 30 days therapy at this dose. Patient Stable? Consider referral to a specialist. All copyrights are reserved by the University of Texas Medical Branch Correctional Managed Care