Mr. Les Brown has been diagnosed with COPD 10 years ago. He has been increasingly shortness of breath doing activities of daily living, needing to rest more frequently and feels he is coughing more often.
Explain the pathophysiology behind the signs and symptoms of COPD
What relationship do you see with Mr. Brown’s vital signs – 26 RR, 91% oxygen saturation, temp: 37.8, HR: 93 BP: 150/70
Describe the goals of care for Mr Brown. Make sure to use the COPD gold standards of care for your plan.
How would you follow up on your proposed plan of care?
Responses need to address all components of the question, demonstrate critical thinking and analysis, and include peer reviewed journal evidence to support the student’s position.
Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria[1]
Classification of severity of airflow limitation in COPD:
In pulmonary function testing, a postbronchodilator FEV₁/FVC ratio of <0.7 is commonly considered diagnostic for COPD. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) system categorizes airflow limitation into stages. In patients with FEV₁/FVC <0.7:
GOLD 1 - mild: FEV₁ ≥80% predicted
GOLD 2 - moderate: 50% ≤ FEV₁ <80% predicted
GOLD 3 - severe: 30% ≤ FEV₁ <50% predicted
GOLD 4 - very severe: FEV₁ <30% predicted.
The GOLD guideline uses a combined "ABE" approach to assess patients according to their level of symptoms and previous history of exacerbations. Symptoms are assessed using the Modified British Medical Research Council (mMRC) or COPD assessment test (CAT) scale. These can be found in the GOLD guidelines. GOLD cautions against the use of the mMRC dyspnea scale alone for assessing patients, as symptoms of COPD go beyond dyspnea alone. For this reason, the CAT is preferred. However, GOLD acknowledges that the use of the mMRC scale is widespread, and so a threshold of an mMRC grade ≥2 is still included to define "more breathless" patients, as opposed to "less breathless" patients, in its assessment criteria. Exacerbations are assessed independently of symptoms to highlight their clinical relevance.