COPD

-	Risk factors include smoking
-	Diagnosis must be made via spirometry with FEV1/FVC < 0.7 and elevated TLCO
    -Mild: > 80%
    -Moderate: 50-79%
    -Severe: 30-49%
    -Very Severe: <30%
-	Consider lifestyle modifications including smoking cessation, pulmonary rehabilitation
    -Smoking with COPD increases risk of lung cancer by 4.5 times compared to smokers without COPD
-	Gold Group (A, B, E): _
    -Group A
        -Dx: 0-1 mod exacerbation/year without hospitalization, CAT < 10, mMRC score 0-1
        -Tx: LAMA, consider LABA if unable to tolerate LAMA and no hx of asthma
    -Group B:
        -Dx: 0-1 mod exacerbation/year without hospitalization, CAT 10 or more, mMRC score of 2 or more
        -Tx: LAMA/LABA combo
    -Group E:
        -Dx: 2+ mod exacerbation/yr without hospitalization, or 1 leading to hospitalization/yr
        -Tx: LABA/LAMA combo and consider ICS if eosinophils are 300 cell/uL or more. If continued poor control consider phosphodiesterase-4 inhibitor such as roflumilast
-	If using ICS, remember to rinse mouth after use and/or use spacer to avoid thrush. ICS increase risk of PNA therefore avoid use unless elevated eosinophils.
-	Long term oxygen therapy is indicated for individuals with resting (> 30 min at rest) PaO2 < 55 mmHg or SpO2 < 88%
    -Long term oxygen therapy is not beneficial in mortality or QOL in individuals with exertional hypoxia
-	May consider surgical intervention for lung volume reduction surgery however it is associated with high mortality
-	Vaccinations include annual influenza and pneumococcal vaccination
    -Consider PneumoRecs App to help in determining which PPSV/PCV vaccine required
    
Modified Medical Research Council Dyspnea Scale: mMRC Dyspnea Scale

COPD Assessment Test: CAT