2) This program is intended for #healthcare providers and is supported by an educational grant from GSK plc. Statement of accreditation & faculty disclosures at https://t.co/0EkFYkmuR5. #Physicians #nurses #PAs #NPs #pharmacists follow this 🧵for 0.5hr🆓CE/#CME credits!
— pulmmed_ce (@Pulmmed_CE) December 21, 2022
3b)
— pulmmed_ce (@Pulmmed_CE) December 21, 2022
🫁 Normally she has no difficulty going up a flight of stairs in her home, but is now huffing & puffing 🌬️ at the top of the stairs
🫁 While she sometimes has allergies that make her cough, it is not a regular thing for her
🫁 She does not have any ankle swelling
3d)
— pulmmed_ce (@Pulmmed_CE) December 21, 2022
🫁 She gets bronchitis 2-3 times per year over the past few years; usually she just goes to urgent care or her PCP and gets an antibiotic Rx
🫁 She has an albuterol inhaler that was Rx'd at some point in the past, but does not use it very much…..
4) The diagnosis of #COPD is established by performing #spirometry. According to the Global Initiative for Chronic Obstructive Lung Disease (@GOLD_COPD), there are some criteria for who should get spirometry: pic.twitter.com/0HKC4VMtYC
— pulmmed_ce (@Pulmmed_CE) December 21, 2022
5b) Seems like our patient who says he has had frequent “bronchitis” should have done a spirometry test over the past few years – this warrants a look into the #EHR for a breathing test……. pic.twitter.com/paNFAoj650
— pulmmed_ce (@Pulmmed_CE) December 21, 2022
7a) It turns out, that when that diagnosis of #COPD was made with #spirometry, a couple other things should have been done:
— pulmmed_ce (@Pulmmed_CE) December 21, 2022
1⃣ an objective tool should have been used to determine how severe her symptom burden was.
7c) It can also be done using the COPD assessment test where a score of 10 or greater reflects significant symptoms. See 🔓https://t.co/5baR3vm13M pic.twitter.com/8TmZp4KEey
— pulmmed_ce (@Pulmmed_CE) December 21, 2022
8b) It turns out, however, that our COPD patients are not always the best at telling us about flare-ups, as per 🔓https://t.co/su8TeRbePD.
— pulmmed_ce (@Pulmmed_CE) December 21, 2022
9b) Group A #COPD patients have low symptom burden (#CAT<10 or #mMRC <2) and have not had 2 or more outpatient #exacerbations in a year or one hospitalized exacerbation in a year
— pulmmed_ce (@Pulmmed_CE) December 21, 2022
9d) Group E #COPD patients have had 2 or more outpatient exacerbations in a year or one hospitalized #exacerbation in a year….regardless of their symptoms! pic.twitter.com/1moKpXXzqn
— pulmmed_ce (@Pulmmed_CE) December 21, 2022
11) So while our patient was just treated with prn #albuterol, really she should have been treated with long-acting combination #bronchodilator therapy given her history of “bronchitis” a couple times a year and her spirometry, which documented #COPD…..
— pulmmed_ce (@Pulmmed_CE) December 21, 2022
13a) Well, recently, a group of #COPD experts gathered to develop the “Rome Proposal”: 🔓https://t.co/wc1ruW4E6K.
— pulmmed_ce (@Pulmmed_CE) December 21, 2022
This document provides a definition of COPD exacerbation: “In a patient with COPD, an exacerbation is an event characterized by dyspnea and/or cough and sputum …
14) There is also a recommended algorithm to determine #COPD severity: pic.twitter.com/AmgRVcFVUZ
— pulmmed_ce (@Pulmmed_CE) December 21, 2022
16) We still should treat her exacerbation though – a short course of #prednisone has been shown to improve #FEV1, oxygen saturation, and recovery time – we prescribe 40mg of prednisone for 5 days because shorter is just as good as a long course! 🔓 https://t.co/riVDtkgfC0
— pulmmed_ce (@Pulmmed_CE) December 21, 2022
18a) We decide to wait bit since her sputum production is limited to the morning and when we ask her if it’s purulent, she says its mostly white and thin.
— pulmmed_ce (@Pulmmed_CE) December 21, 2022
19) She checks in with us a three days later – feeling better! Some lingering cough, but her breathlessness is improving, and she can now get up a flight of stairs without too much trouble. Her O2 saturation (she checks at home) is stable at 94%. pic.twitter.com/U32bafR7ZV
— pulmmed_ce (@Pulmmed_CE) December 21, 2022
21a) This is really important…..and too rarely considered! In an integrated health plan the percentage of patients on maintenance #COPD therapy went from just 61% before an #exacerbation to 69% following an exacerbation. See 🔓https://t.co/HgWF6rWL9x.
— pulmmed_ce (@Pulmmed_CE) December 21, 2022
21c) This was documented in both the IMPACT study 🔓https://t.co/F7MIdGysSs and the ETHOS study 🔓 https://t.co/EvKzRCvRIR, both of which compared triple inhalers to duals and documented clear benefits in exacerbation reduction and lung function improvement
— pulmmed_ce (@Pulmmed_CE) December 21, 2022
23) We prescribe our patient triple therapy, we encourage her to exercise and suggest she attend #pulmonary_rehabilitation, and we educate her about COPD, why we are treating it, and our primary goal of preventing exacerbations!
— pulmmed_ce (@Pulmmed_CE) December 21, 2022
24b) Look back up to tweet 10 . . . it’s groups B & E!
— pulmmed_ce (@Pulmmed_CE) December 21, 2022
25b) It’s c—short-acting bronchodilators are not part of maintenance triple therapy for #COPD, though they may still be useful short-term for acute breathlessness.
— pulmmed_ce (@Pulmmed_CE) December 21, 2022
26) And YOU just earned 0.5h 🆓CE/#CME! Go to https://t.co/0grobuOYSt and claim your certificate. And FOLLOW us for more expert-led education, right here on Twitter. Tell your friends! I am @RKalhan and I 🙏you for joining us!
— pulmmed_ce (@Pulmmed_CE) December 21, 2022