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8/16/2019 Chronic Obstructive Pulmonary Disease Managing Exacerbations of Copd
http://slidepdf.com/reader/full/chronic-obstructive-pulmonary-disease-managing-exacerbations-of-copd 1/15
Managing eManaging exacerbations of COPDxacerbations of COPD
NICE Pa+ a * b)!%g +&ge+ e) a## NICE g !da%ce, ( a#!+ *+a%da)d* a%d &+ e) NICE!%f&)$a+!&% &% a *'ec! c +&'!c.
NICE Pa+ a * a)e !%+e)ac+! e a%d de*!g%ed +& be *ed &%#!%e. T e a)e 'da+ed)eg #a)# a* %e NICE g !da%ce !* ' b#!* ed. T& !e + e #a+e*+ e)*!&% &f + !* 'a+ a*ee:
++'://'a+ a *.%!ce.&)g. "/'a+ a */c )&%!c-&b*+) c+! e-' #$&%a) -d!*ea*ePa+ a #a*+ 'da+ed: 04 Feb) a) 2016
T !* d&c $e%+ c&%+a!%* a *!%g#e 'a+ a d!ag)a$ a%d *e* % $be)!%g +& #!%" + eb& e* +& + e a**&c!a+ed )ec&$$e%da+!&%*.
C&' )!g + NICE 2016. A## )!g +* )e*e) ed
8/16/2019 Chronic Obstructive Pulmonary Disease Managing Exacerbations of Copd
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Managing eManaging exacerbations of COPDxacerbations of COPD NICE Pathways
Chronic obstructivChronic obstructive pulmonary disease pathe pulmonary disease pathwa wayyC=> J # CE 2016.
Page 2 &f 15
8/16/2019 Chronic Obstructive Pulmonary Disease Managing Exacerbations of Copd
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1 Person over 16 with exacerbation of COPD
#= = = ; =
2 Self-management
= = = C$ D = -; ; = ; = >= > =;> = ;> =; = = .
= = = >= > =;> = ;> =; = = :
= = = = >
= ( = ) = > > ; >
= = = > = = = ;> =; .
= = = C$ D = = = = = = = = > =; = > = -; ; (= = = > 6 > = = = = > = = ).
>> => = = ;= = .
-; ; > = = = > = = = = ;> = .
F= = ; = = ; = ; # CE > = ; =>.
3 Treatment at home or in hospital?
F = = = = ; = > 11= = = > = > .
H= > - - =; - ; = = = > = = C$ D = = =
= ; = = > .
Managing eManaging exacerbations of COPDxacerbations of COPD NICE Pathways
Chronic obstructivChronic obstructive pulmonary disease pathe pulmonary disease pathwa wayyC=> J # CE 2016.
Page 3 &f 15
8/16/2019 Chronic Obstructive Pulmonary Disease Managing Exacerbations of Copd
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8/16/2019 Chronic Obstructive Pulmonary Disease Managing Exacerbations of Copd
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6 Delivery systems for inhaled therapy
B= - = ; > = = C$ D.
= = ; = = = , = = = = > ; = =
= = - == = = ; > ; =; = > . 2004
> > > = = = =;> , = ( = = = > > ). = > = ;
; = .
= > = > > > = .
7 Treatment options
#= = = ; =
8 Antibiotics
A = = = = = C$ D = = = ;=> > ;.
= = ;= > > ;do not need = > = = = = = > = = > ;= .
;> ; = ; => , ; = , = . * ;> = ; > = = =
= ; = = = .
* > ; = , >> => = = ; = = = =; .
# CE > = > = > ;= .
Managing eManaging exacerbations of COPDxacerbations of COPD NICE Pathways
Chronic obstructivChronic obstructive pulmonary disease pathe pulmonary disease pathwa wayyC=> J # CE 2016.
Page 5 &f 15
8/16/2019 Chronic Obstructive Pulmonary Disease Managing Exacerbations of Copd
http://slidepdf.com/reader/full/chronic-obstructive-pulmonary-disease-managing-exacerbations-of-copd 6/15
F= = ; = = ; = ; # CE > =; =>.
9 Corticosteroids
= = = = = = = = , = = = > , > ; = = >
C$ D.
= = = , = = = = = => =;; = =
.
= = = > = = = > = ; ( -; ; > 3 > ).
= = 30 ; = = > = 7 = 14 .
=;; = = = = = ;should not be longer 14 = > = = > .
F= = =>> = = = = > =;; = = = = >=; B # = F= ; .
$ =>= = > => = = > = = = = = .
= ; = => ; ; = = ; => = = > .
, > = =; = > , = =, = = => = = = ; .
10 Oxygen therapy
= = = ; > = = C$ D, = = ; == .
Managing eManaging exacerbations of COPDxacerbations of COPD NICE Pathways
Chronic obstructivChronic obstructive pulmonary disease pathe pulmonary disease pathwa wayyC=> J # CE 2016.
Page 6 &f 15
8/16/2019 Chronic Obstructive Pulmonary Disease Managing Exacerbations of Copd
http://slidepdf.com/reader/full/chronic-obstructive-pulmonary-disease-managing-exacerbations-of-copd 7/15
, = = = > $ 2
( = = > = = = ).
= ; = = > = = = > = = C$ D = . C
> = ; = = ; = = C$ 2 = >H.
Quality standards
= = ; = > = > .
Chronic obstructive pulmonary disease in adults quality standard
6. E; = =
11 Physiotherapy
= > >= > = > ; = = = > = = C$ D, = > > ;.
12 Hospital only
#= = = ; =
13 Intravenous theophylline
= => = = = ; ; = = = C$ D >= = = = = .
C = = => = = = >= = > = = => .
=> = ;= = 24 = = ; ; .
Managing eManaging exacerbations of COPDxacerbations of COPD NICE Pathways
Chronic obstructivChronic obstructive pulmonary disease pathe pulmonary disease pathwa wayyC=> J # CE 2016.
Page 7 &f 15
8/16/2019 Chronic Obstructive Pulmonary Disease Managing Exacerbations of Copd
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14 Invasive ventilation
= = C$ D = ; = , = = = .
D = = C$ D, = , B" , ; = = ,=;= > = ; = = = = , = FE 1 , = = = . # =1
= = = .
# = = = > = = = =; = .
15 Non-invasive ventilation and doxapram
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> > = = =! $ = = > = = = == - ;# .
# = ; = = = > > > =
= > => ; ; > .
=;; # = = >> = , = > = = ;
* > = # = > = = = = = = = > = .
=;; = > ; = # = =>> => .
Quality standards
= = ; = > = > .
Chronic obstructive pulmonary disease in adults quality standard
7. #= - =
Managing eManaging exacerbations of COPDxacerbations of COPD NICE Pathways
Chronic obstructivChronic obstructive pulmonary disease pathe pulmonary disease pathwa wayyC=> J # CE 2016.
Page 8 &f 15
8/16/2019 Chronic Obstructive Pulmonary Disease Managing Exacerbations of Copd
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16 Monitoring in hospital
' = = ;= = ; = ;> =; = = = = > .
= ; = = ;= = = = > = - > > , == > = .
; == ; ; = = ;= = = = > > = = > > = = , .
D ;= = = EF = FE 1 should not be performed routinely = ;= = = =;
= ; = ; =;> =; ; .
17 Discharge from hospital
> =; = ; > = .
= - = => ; ; = = = >
.
= > = = > = = = = ; == = .
A > = = > ( >> => ) = = .
(= =; ) = >> => = ; = = ; =
= = ; = , = , = .
A ; = = = - > =; ( , = , = >>= ) = ; = .
B = > , > , ; > = = ; . * ; = = ; =
; ; > .
Managing eManaging exacerbations of COPDxacerbations of COPD NICE Pathways
Chronic obstructivChronic obstructive pulmonary disease pathe pulmonary disease pathwa wayyC=> J # CE 2016.
Page 9 &f 15
8/16/2019 Chronic Obstructive Pulmonary Disease Managing Exacerbations of Copd
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F= = ; = = = = =; , # CE > = = ==; . = # CE > = =; = = > => .
Quality standards
= = ; = > = > .
Chronic obstructive pulmonary disease in adults quality standard
2.
18 Back to overview
C = = > ;= / C$ D =
19 NICE pathway on medicines optimisation
" => ; =
Managing eManaging exacerbations of COPDxacerbations of COPD NICE Pathways
Chronic obstructivChronic obstructive pulmonary disease pathe pulmonary disease pathwa wayyC=> J # CE 2016.
Page 10 &f 15
8/16/2019 Chronic Obstructive Pulmonary Disease Managing Exacerbations of Copd
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Factors to consider when deciding where to manage exacerbations
=; ?
= > ?
A = => =; #=
B "
G = = G== == /=
! = G==== / = =
C = #=
*= > > = ; #=
! = = = #= ; ;>
A ! $ #=
= ; G== ! = / ==>
A = = #=
& > = = #=
Managing eManaging exacerbations of COPDxacerbations of COPD NICE Pathways
Chronic obstructivChronic obstructive pulmonary disease pathe pulmonary disease pathwa wayyC=> J # CE 2016.
Page 11 &f 15
8/16/2019 Chronic Obstructive Pulmonary Disease Managing Exacerbations of Copd
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=;= (> - > )
#=
$ 2 < 90% #=
C = +- #=
A >H K 7.35 < 7.35
A $ 2 K 7 < 7
Glossary
ASA
A; = = A = =
ATS
A; = =
BODE
= ; , = = = , > = >
BTS
B = =
CEN
C=; I E => #= ; = (E => C=;; = = )
COPD
= = > ;=
Managing eManaging exacerbations of COPDxacerbations of COPD NICE Pathways
Chronic obstructivChronic obstructive pulmonary disease pathe pulmonary disease pathwa wayyC=> J # CE 2016.
Page 12 &f 15
8/16/2019 Chronic Obstructive Pulmonary Disease Managing Exacerbations of Copd
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cor pulmonale
= = > , ; ' = > ;= ' => = = = ; = = .
= = > ;= > = = = = =; > ; > = = = = , = =>;
= > > = ;
ECG
= = ;
ERS
E => & > = =
FEV1
= > = = ; 1 =
FVC
= >
GOLD
= = = =
ICS
= = =
LABA
= - 2 =
LAMA
= - ; =
Managing eManaging exacerbations of COPDxacerbations of COPD NICE Pathways
Chronic obstructivChronic obstructive pulmonary disease pathe pulmonary disease pathwa wayyC=> J # CE 2016.
Page 13 &f 15
8/16/2019 Chronic Obstructive Pulmonary Disease Managing Exacerbations of Copd
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LTOT
= - ; = >
MRC
" & C=
NIV
= - =
PaO2
> > = = ==
PaCO2
> > = = = ==
PEF
> > = =
SABA
= - 2 =
SAMA
= - ; =
SaO2
= = = ==
TLCO
= ;= = =
Managing eManaging exacerbations of COPDxacerbations of COPD NICE Pathways
Chronic obstructivChronic obstructive pulmonary disease pathe pulmonary disease pathwa wayyC=> J # CE 2016.
Page 14 &f 15
8/16/2019 Chronic Obstructive Pulmonary Disease Managing Exacerbations of Copd
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Sources
C = = > ;= (2010) # CE CG101
Your responsibility
> > = # CE, = = = . = = #H , = = ,
> , = =;; = > = = = = = > = = , ; = = . ;> ; = =
>= = = =;; = /= > = . C=;; = > =
; >= = ;> ; , = = , = = ; = = = > =;= =
=>>= . #= = > = = =;> = .
Copyright
C=> J # = = H C E 2016. A . #=> ; = = = > , ; > == = = - = -> = > >= . #= > = = = = =;; =
= = =;; > >= , = = > ; = = # CE.
Contact NICE
# = = H C E! 1A, C =
" "1 4B
. .= .
@ .= .
0845 003 7781
Managing eManaging exacerbations of COPDxacerbations of COPD NICE Pathways
Chronic obstructivChronic obstructive pulmonary disease pathe pulmonary disease pathwa wayyC=> J # CE 2016.
Page 15 &f 15
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