A patient with stable chronic obstructive pulmonary disease (COPD) can be managed based on the GOLD (Global Initiative for Chronic Obstructive Lung Disease) stage and other clinical findings.
Patient selection: FEV1/FVC ratio < 0.70 defines GOLD Stages 1 to 4.
Gold Stage
Additional Finding
Management
1
risk factors avoidance (smoking, etc.)
immunization (influenza, pneumococcal)
short-acting bronchodilators as needed
2
pulmonary rehabilitation
2
persistent symptoms
add inhaled long-acting bronchodilators
3
regular exacerbations (>= 3 in 2 year period)
add inhaled corticosteroids
4
respiratory failure
add home oxygen therapy
4
consider lung reduction surgery
where:
• In the implementation I will add Gold Stage 0 (at risk) and move risk factor avoidance to that group)
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