COPD
ACTIONPLAN / Remember to / Spirometry Most Recent / Age ______
Get A Flu Shot Every Year! / Date ______ / Height ______
Be Current with your Pneumococcal Shot! / FEV1 ______ / Weight ______
Do not Smoke or Use Tobacco / FEV1/VC Ratio ______ / BMI ______
ZONES /
Maintenance Therapy
/

Rescue Therapy

Stable

/ MEDICATIONS / Strength/delivery / Dose / Frequency
Fomoterol Perforomist /  100  200 / __puffs / 4-6
Fenoterol Berotec N / __puffs
Ipratropium bromide MDIAtrovent / 20  40 / __puffs / 6-8
Fenoterol/ Ipratropium Berodual N / __puffs / 6-8
Salbutamol/ Ipratropium
Combivent, DuoNeb /  75/15 MDI / __puffs / 6-8
/ MEDICATIONS / Strength
delivery / Dose / Frequency
Albuterol Proventil /  100 MDI  200 MDI
 5mg Pill / __puffs / 4-6
Levalbuterol MDI Xopenex /  45  90 / __puffs / 6-8

Caution

/ SAME AS ABOVE ZONE AND ADD
MEDICATIONS / Strength/delivery / Dose / Frequency
Fomoterol MDI/DPI Foradil, Perforomist /  4.5- 12 / __puffs / 24
Salmetrol MDI/
pi Serevent /  25  50 / __puffs
Albuterol/ Ipratropium MDI Combivent, DuoNeb /  200/80
 75/15 / __puffs /
-8
/ MEDICATIONS / Strength/delivery / Dose / Frequency
Albuterol Proventil /  100 MDI  200 MDI
 5mg Pill / __puffs / 4-6
Levalbuterol MDI Xopenex /  45  90 / __puffs / 6-8
Call Physician
/ SAME AS ABOVE ZONES AND ADD
MEDIC
TIONS / Strength/delivery / Dose / Frequency
Formoterol/Budesonide DPI Symbicort /  4.5/160  9/320 /  __puffs
Salmeterol/Fluticasone propionate Advair /  50/100 250 500 DPI
 25/50, 125,250MDI /  __puffs
Tiotropium Spiriva /  18 DPI  5 S
I /  __puffs / 24
Beclomethasone DPI QVAR /  50 100
200  400 /  __puffs
Budesonide DPIPulmicort /  100  200  400 /  __puffs
Fluticasone propionate (MDI/DPI)Flovent /  50  100
 250  500 /  __puffs
/ Make an urgent appointment with your doctor even if symptoms improve
MEDICATIONS / Strength/delivery / Dose / Frequency
Albuterol Proventil /  100 MDI  200 MDI
 5mg Pill / __puffs / 4-6
Levalbuterol MDI Xopenex /  45  90 / __puffs / 6-8
Emergency
Unabletodoanyactivity
Morewheezing
Increasedshortnessofbreath
Unabletoeatorsleep
Increasedtirednesssleepiness
/ CONTINUE ABOVE MEDICATIONS AND ADD
MEDICATIONS / Strength/delivery / Dose / Frequency
Prednisone / 5mg 10mg
20mg 60mg
Other
/ Call 911 or go to Emergency Department if symptoms worsen.
Make an urgent appointment with your doctor even if symptoms improve
MEDICATIONS / Strength/delivery / Dose / Frequen
y
Albuterol Proventil /  100 MDI  200 MDI
 5mg Pill / __puffs / 4-6
Levalbuterol MDI Xopenex /  45  90 / __puffs / 6-8
Plan reviewed and copy given to patient: / Date: / Allow patient to take medications at work / Yes No
Plan re-reviewed and copy given to patient: / Date:
Provider Name: Address: Phone Number: / Patient Name: DOB:
Plan authorized by: / MRN:
Key Points for Step-up Therapy -Pharmacotherapy for patients with COPD is based on a step-up approach:
  1. Therapy to address symptoms should make use of non-pharmacologic intervention to improve outcomes (i.e., smoking cessation, education, rehabilitation, and pulmonary rehabilitation).
  2. Pharmacotherapy should balance overall efficacy which includes acceptance and adherence against risks for adverse effects (toxicity).
  3. Patient symptomatic responses such as dyspnea, as well as a reduction in exacerbations, should be the primary basis for determining response to therapy.
  4. Continue ongoing evaluation of the patient’s response to therapy and progression of disease.
  5. As COPD progresses, additional pharmacotherapy is usually needed.
  6. Patient’s preference should be considered to improve acceptance and adherence to therapy.
  7. Patients with severe airflow limitation (FEV1 < 50 percent predicted) and minimal symptoms should be considered for a trial of pharmacologic therapy.
  8. COPD severity based on symptoms and FEV1 should always be documented initially and reassessed periodically based primarily on symptomatic progression of COPD.
  9. The Modified Medical Research Council (MMRC) scale of dyspnea, in addition to clinical assessment, is indicated to grade symptom severity.
  10. Treatment is predominantly based on symptoms and a suggested stepped-up approach is recommended.

Step-Care Pharmacotherapy in COPD

Step / Symptoms / Maintenance Therapy / Rescue therapy / Other Interventions
A / Asymptomatic / No medication indicated / -- / Smoking cessation; influenza, and other vaccinations
B / Symptoms less than daily / No scheduled medication indicated / SABA / Smoking cessation; influenza, and other vaccinations
C / Symptoms not controlled with rescue therapy or daily symptoms / Scheduled SAAC
or
Combination SABA + SAAC / SABA / Smoking cessation; influenza, and other vaccinations
D / Symptoms not controlled / Combination SAAC + LABA
or
LAAC / SABA / Smoking cessation; influenza, and other vaccinations
Consider Pulmonary Rehabilitation
E / Symptoms not controlled / Combination LABA + LAAC / SABA / Smoking cessation; influenza, and other vaccinations
Refer to Pulmonary Rehabilitation
F / Exacerbations of more than one per year and severe disease (FEV1 < 50%) / Consider adding an inhaled
glucocorticoid / SABA / Smoking cessation; influenza, and other vaccinations
Refer to Pulmonary Rehabilitation
SAAC – Short-acting anticholinergic; SABA – Short-acting beta-agonist; LABA – Long-acting inhaled beta-agonist; LAAC – Long-acting anticholinergic

Daily Tips for Keeping Well and Living with COPD

Know What To Do in an Emergency

COPD Action Plan Have an Action Plan: it describes actions for most situations including emergencies

If you get worse, increase treatments according to your plan

Notify your MD if you get worse

Have a readily available supply of your medications; Don’t let your medications expire

If you are on Oxygen, Keep it on, know your settings and follow MD advised changes or limits

Prevent Lung Function Worsening

SmokingQUIT smoking – it’s never too late

Smoking cessation helps save lung tissue and also lung function

Ask for assistance to stop (tips, medications, resources, hot-lines)

Good HygieneWash hands frequently to avoid infection; avoid potential infection sites

Flu vaccineAvoid serious flu related illness. Get an annual fall flu shot!

Pneumococcal vaccinationCOPD patients are in a high risk group to have serious pneumonia .

Pneumococcal vaccination is advised.

At age 65 and revaccination is advised if 5years elapsed since first vaccination

OrganizeYour medicines, your activities, your clothes, your kitchen, for easy access

Avoid Inhaled Irritants Get regular checkups Get oxygen level assessed if advised

Keep in Shape

ExerciseDo in short units of time for 5 to 15 minutes up to 3 to 4 times a day most days of the week with rests

Walking is the best exercise; but exercise and strengthen upper body too. Weak muscles lead to worsening respiratory state

Goal is strengthening and toning muscles and maximizing endurance to decrease air hunger.

Breathing TechniquesPursed-Lip Breathing- Inhale through nose, exhale through tightened lips

BreathHolding and Cough (Huff technique) - Inhale deeply; hold breath for 5 – 10 seconds; then cough during exhalation

For mucus expectoration, lean forward, huff repeatedly, relax and huff again

NutritionAttain a healthy body weight; underweight state can lead to weak respiratory muscles; being overweight puts a strain on muscles, increases respiratory demand and increases shortness of breath

Keep good sleep habits

Lawson # 6/11 Reviewed Things you can do to manage your COPD. White copy – Patient Yellow copy - Chart