By vgreene, 5 March, 2019 Avoid aggravating factors. If environment risks: Reduce occupational dust/fume/gas and indoor/outdoor pollutant exposure [B]
By vgreene, 5 March, 2019 Vaccinate COVID 19 according to nat l recs B Flu annually A Tdap if not prev received B Zoster if 50 yo B If 65 yo both pneumococcal vax PCV13 PPSV23 B If
By vgreene, 5 March, 2019 If smoker, cessation tx [A] using ≥1 first-line tx:1 Nicotine gum/lozenge/inhaler/spray/patch or meds (bupropion SR, nortriptyline, varenicline); use drugs along w/ intervention program; counsel7 @ every visit. Efficacy of e-cig as cessation aid uncertain
By vgreene, 5 March, 2019 Pulmonary rehab5 recommended Encourage physical activity No demonstrated benefit for integrative care or telehealth B
By vgreene, 5 March, 2019 Ventilation. Consider NPPV in select pts (eg, if persistent daytime hypercapnia)4
By vgreene, 5 March, 2019 Eval response, escalate and de-escalate as needed. ✓inhaler technique every visit
By vgreene, 5 March, 2019 Continue short acting BD for sx rescue SAMA ipratropium SABA albuterol levalbuterol for all pts
By vgreene, 5 March, 2019 If on LAMA+LABA (+/- ICS): Switch inhaler device type and/or switch specific drugs in the combination. Investigate dyspnea causes. If on ICS, consider eliminating it2