By vgreene, 14 February, 2017 Vaccinate: flu [B]. If ≥65 yo: pneumococcal (both PCV13 and PPSV23) [B]; PPSV23 also recommended in pts
By vgreene, 14 February, 2017 Avoid aggravating factors. If environment risks: Reduce occupational dust/fume/gas and indoor/outdoor pollutant exposure [B]
By vgreene, 14 February, 2017 If smoker, cessation tx [A] using ≥1 first-line tx:1 Nicotine gum/inhaler/spray/patch or meds (bupropion SR, varenicline); use drugs along w/ intervention program; counsel9 @ every visit. Efficacy of e-cig as cessation aid uncertain
By vgreene, 14 February, 2017 Combine long-acting inhaled BDs;1 consider O2 tx, surgery/procedures, ventilation for COPD Group D2 pts
By vgreene, 14 February, 2017 Ventilation: Consider NPPV in select pts (eg, if persistent daytime hypercapnea)7
By vgreene, 14 February, 2017 Eval effect: If further exac, escalate either to LAMA/LABA/ICS triple combo, or switch to LABA+ICS.1 If exac still occur on LAMA/LABA/ICS: Consider adding roflumilast,1 or adding macrolide,1 or stopping ICS. ✓inhaler technique each visit
By vgreene, 14 February, 2017 Start LAMA+LABA combo:1 aclidinium/formoterol, glycopyrronium/formoterol, tiotropium/olodaterol, umeclidinium/vilanterol. If asthma-COPD overlap, LABA/ICS1 may be first-line
