#86: COPD: Diagnosis, treatment, PFTs, and nihilism

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Take a deep breath and tune in to this week’s episode full of COPD diagnosis and management pearls, with expert Dr. Denitza Blagev, a pulmonologist, intensivist, and Medical Director for Quality, Speciality Care at Intermountain Healthcare in Utah with a particular interest in physician wellness and issues related to women in medicine. We cover: history taking, interpreting PFTs, patient counseling, inhalers and medications, exacerbations, antibiotics, steroids, and who needs BIPAP...so basically everything you ever wanted to know about chronic obstructive pulmonary disease. Take our self assessment here.

Sponsored by @nephmadness. Registration opens March 15th at AJKDblog.org

Written and produced by: Leah Witt, MD, Cyrus Askin, MD. Edited by Matthew Watto, MD

Full show notes available at http://thecurbsiders.com/podcast

Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Time Stamps

  • 00:00 NephMadness announcement
  • 01:10 Disclaimer
  • 01:45 Intro
  • 03:50 Guest bio
  • 05:03 One liner; What advice would you give our younger self?; Should I do a fellowship?; Book recommendations
  • 10:30 Picks of the week
  • 15:50 Case of COPD from Kashlak Memorial
  • 16:55 Initial approach to a potential case of COPD
  • 18:34 Misdiagnosis of COPD
  • 20:10 Classic spirometry in COPD and GOLD 0
  • 21:30 Diagnosis of emphysema
  • 23:18 Diagnosis of chronic bronchitis
  • 24:54 Counseling the patient with a new diagnosis of COPD
  • 27:00 Spirometry
  • 28:45 How to read PFTs
  • 33:29 How to order PFTs and get what you want
  • 36:00 Why does pre- and post-bronchodilator response matter?
  • 38:45 Asthma COPD overlap syndrome
  • 40:13 Staging of COPD, does it matter?
  • 42:50 Prognosis in COPD
  • 45:00 Therapies with mortality benefit
  • 48:29 Therapies to improve symptoms and prevent exacerbations
  • 52:00 Azithromycin as chronic therapy
  • 53:00 Counseling patients on therapy
  • 55:00 Short acting inhalers in COPD
  • 56:20 Treatment of COPD exacerbations
  • 59:18 Antibiotics, who needs them in exacerbation
  • 61:52 Nebulized inhaled steroids
  • 63:18 Duration of antibiotics and steroids during an exacerbation
  • 66:30 Who needs BIPAP chronically?
  • 69:22 Who needs BIPAP during an exacerbation?
  • 71:33 How often should PFTs be repeated?
  • 73:00 When should we suspect PE in COPD exacerbation?
  • 74:25 Which labs should be check in the initial COPD workup?
  • 76:46 Take home points

Tags: copd, chronic, pulmonary, disease, asthma, emphysema, bronchitis, inhaler, nebulizer, steroids, embolism, exacerbation, bipap, cpap, antibiotics, azithromycin, doxycycline, mortality, oxygen, spirometry, dlco, fev1, fvc, pfts, #nephmadness, assistant, care, doctor, education, family, foam, foamed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

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