Mount Carmel Health Partners Clinical Guidelines Chronic Obstructive Pulmonary Disease

Management of Severe but not Life Threatening Exacerbations • Assess severity of symptoms, arterial blood gas, chest radiograph • Administer supplemental oxygen therapy; obtain serial arterial blood gas, venous blood gas, and pulse oximetry measurements • Bronchodilators: increase doses and/or frequency of short-acting; combine short-acting beta-2 agonists and antimuscarinics; consider use of long-acting bronchodialators when patient becomes stable use spacers, chambers, and air-driven nebulizers • Add oral or intravenous corticosteroids • Consider antibiotics if there are signs of bacterial infection • Identify and treat associated conditions, i.e., heart failure • Monitor fluid balance and nutrition • Consider subcutaneous heparin or low molecular weight heparin to prevent DVT • Closely monitor the patient’s condition Patient Education • Smoking cessation • Education on prescribed medications and/or oxygen therapy • Exercise and nutrition counseling • Recognition of exacerbations Palliative and Hospice Care • The goal of palliative care is to relieve suffering, optimize function, provide emotional and spiritual support and support the best quality of life regardless of the stage of the disease. Palliative care has been shown to improve quality of life, reduce symptoms, and even prolong survival for some patients. • Early referral to palliative and/or hospice care. • Hospice care assists with the delivery of end of life care for patients who are terminally ill and predicted to have less than 6 months to live. ICD-10 - Chronic Obstructive Pulmonary Disease (COPD) ICD 10 Description J40* Bronchitis, not specified as acute or chronic J41.0 Simple chronic bronchitis J41.1 Mucopurulent chronic bronchitis J44.9 Chronic obstructive pulmonary disease, unspecified J43.9* Emphysema, unspecified J45.20 Mild intermittent asthma, uncomplicated J45.22 Mild intermittent asthma with status asthmaticus J45.21 Mild intermittent asthma with (acute) exacerbation J44.9 Chronic obstructive pulmonary disease, specified J44.0 Chronic obstructive pulmonary disease with acute lower respiratory infection J44.1 Chronic obstructive pulmonary disease with (acute) exacerbation J45.990 Exercise induced bronchospasm J45.991 Cough variant asthma J45.909* Asthma, unspecified type, unspecified J45.902 Asthma, unspecified type, with status asthmaticus J45.901 Asthma, unspecified type, with (acute) exacerbation *Code to the highest degree of specificity COPD - 6

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