COPD Exacerbation Prevention

Aka: COPD Exacerbation Prevention, COPD Tertiary Prevention

1. See Also
   1. COPD Management
   2. Medications in COPD Management
   3. Acute Exacerbation of Chronic Bronchitis
   4. Antibiotic Use in COPD Exacerbation
   5. COPD
   6. Chronic Bronchitis
   7. Emphysema
   8. Alpha-1-Antitrypsin Deficiency
   9. COPD Staging
   10. COPD Action Plan
2. Prevention: General
   1. Evaluate and Manage comorbidity
      1. Cardiovascular disease is a top cause of mortality in COPD patients
   2. Immunizations for smokers or COPD aged 19 to 64 years old
      1. Annual Influenza Vaccine
         1. Wongsurakiat (2004) Chest 125:2011-20 [PubMed]
      2. Pneumococcal Vaccine (Pneumovax) one dose
         1. At age 65 years old, repeat Pneumovax as well as Prevnar (1 year apart)
   3. Body habitus
      1. Overweight "Blue boater": Attempt weight loss
      2. Thin "Pink Puffer": Nutritional Supplementation
   4. Prevent hospital admissions
      1. See GOLD Criteria and stepped approach below
      2. See COPD Action Plan
3. Prevention: Tobacco Cessation
   1. See Tobacco Cessation
   2. Tobacco Cessation is the single most important intervention
      1. Coughing stops in 77% of those quitting smoking
      2. Cough improves in 17%
      3. Cough may stop within 4 weeks of quitting (54%)
      4. Quitting decreases all cause mortality >15 years
      5. Quitting smoking alters the decline in lung function (decreases FEV1 decline)
   3. Make use of Smoking Cessation adjuncts (Bupropion, Varenicline, Nicotine Replacement)
   4. Educating patients about their lung age (estimated via Spirometry) is effective motivation
      1. Parkes (2008) BMJ 336(7644): 598-600 [PubMed]
4. Prevention: Pulmonary Rehabilitation
   1. See Pulmonary Rehabilitation
   2. Indicated in moderate to severe COPD with Dyspnea-limited activities or impaired quality of life
   3. Includes Pulmonary Rehabilitation Exercise, nutritional counseling, education and behavioral modification
   4. Reduces Dyspnea, improves Exercise ability and improves quality of life if continued for at least 6 months
      1. Salman (2003) J Gen Intern Med 18(3): 213-21 [PubMed]
5. References
   1. Gentry (2017) Am Fam Physician 95(7): 433-41 [PubMed]