[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-359572-105":53,"doc-detail-359572-en":127},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":120,"head_meta":122,"extra_data":124,"updated_unix":126},105,"en","copd-pathway-v2-april-2026","COPD pathway - v2 - April 2026","","Clinical pathway outlining when to suspect and diagnose COPD, using symptoms and spirometry criteria (post-bronchodilator FEV1/FVC \u003C0.7 or LLN). Provides severity stratification by FEV1 % predicted, symptom assessment considerations, and referral guidance to a respirologist and pulmonary function laboratory. Details preventative measures (vaccinations, smoking cessation, advanced care planning) and an exacerbation action plan. Summarizes stable COPD pharmacologic escalation from LABA/LAMA to triple therapy, plus advanced therapies such as home oxygen and palliative approaches.",{"@graph":63,"@context":119},[64,80,102],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":11,"@type":70,"position":76},"https://docshare.wps.com/template/presentations/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/copd-pathway-v2-april-2026/359572/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/copd-pathway-v2-april-2026/359572.png","ImageObject",442,249,{"name":88,"@type":89},"Patrick","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-22","2026-09-23",true,{"@type":98,"interactionType":99,"userInteractionCount":101},"InteractionCounter",{"@type":100},"ViewAction",9,{"@type":103,"mainEntity":104},"FAQPage",[105,111,115],{"name":106,"@type":107,"acceptedAnswer":108},"When should clinicians suspect COPD?","Question",{"text":109,"@type":110},"Suspect COPD with chronic and progressive dyspnea, recurrent wheeze, chronic cough, and recurrent respiratory infections, particularly with tobacco smoke exposure and other risk factors.","Answer",{"name":112,"@type":107,"acceptedAnswer":113},"How is COPD diagnosed and confirmed?",{"text":114,"@type":110},"Diagnosis requires spirometry showing a post-bronchodilator FEV1/FVC ratio \u003C0.7 (or LLN). If airflow obstruction is reversible with bronchodilators (FEV1 improves by ≥200 ml and ≥12%), asthma is more likely; if not reversible, COPD is confirmed.",{"name":116,"@type":107,"acceptedAnswer":117},"What is the recommended approach for stable COPD medication escalation?",{"text":118,"@type":110},"Start based on FEV1 % predicted and symptom burden: FEV1 ≥80% with few symptoms and no prior exacerbations uses either LABA or LAMA; FEV1 \u003C80% uses LABA plus LAMA (or a combination). If symptomatic despite dual therapy, switch to LAMA/LABA/ICS triple therapy, and consider add-on azithromycin for patients with recurrent exacerbations despite triple inhaled therapy.","https://schema.org",{"og:url":78,"og:type":121,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":123,"canonical":78},"index,follow",{"doc_id":125,"site_id":56},359572,1791748925,{"code":4,"msg":5,"data":128},{"doc_id":125,"user_id":129,"nickname":88,"user_avatar":130,"doc_module":9,"category_id":8,"category_name":11,"doc_title":59,"doc_description":61,"doc_content":131,"file_id":132,"file_url":133,"file_type":134,"file_size":135,"view_count":101,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":79,"language":136,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":61,"update_tm":140,"read_time":73},549758146520,"https://ap-avatar.wpscdn.com/avatar/80002397d8c0411e94?_k=1775819394049821470","When to suspect COPD:  \n- Chronic and progressive dyspnea  \n- Recurrent wheeze  \n- Chronic cough  \n- Recurrent respiratory infections  \n- Risk factors including exposure to tobacco smoke  \nDiagnosis requires spirometry demonstrating post-bronchodilator FEV1/ FVC ratio \u003C0.7 (or LLN) . Spirometry sites in Kingston  \nIs the airflow obstruction reversible with  \nbronchodilators (FEV1 improves by 􀁴200ml AND ≥12%)?  \nDiagnosis is more likely to be asthma  \nNo  \nCOPD is confirmed  \nDetermine severity  \n\n| Mild: FEV1􀁴80% predicted | Consider referring to a respirologist if not responding to treatment as outlined below |\n| --- | --- |\n| Moderate: FEV1 50-80% predicted | Consider referring to a respirologist if symptomatic or FEV1\u003C70%, document GOC discussion |\n| Severe: FEV1 30-49% predicted | Patient should be seen by a respirologist, document GOC discussion |\n| Very Severe: FEV1\u003C30% | Patient should be seen by a respirologist, document GOC discussion |\n\nAssessing symptoms – Consider:  \nCOPD Assessment Test (CAT) MRC grade  \nRefer your patient:  \nPulmonary Function Laboratory at KHSC – HDH site  \n Initiating treatment for COPD   \nPreventative measures for all COPD patients  \nVaccinations: Pneumococcal vaccine, yearly influenza vaccine, yearly covid vaccine, Herpes Zoster vaccine Smoking cessation: Counselling, nicotine replacement (STOP program), Bupropion, Varenicline ( Resources) Advanced care planning: Discuss and document goals of care and wishes in the event of an exacerbation COPD action plan:  \n- For increased dyspnea, cough: prednisone 40mg po daily x 5 days and  \n- If fever or green/brown sputum: add antibiotics ex: Amox-Clav 875mg BiD x 5-7 days, Levofloxacin 750mg po daily x 5-7 days; Moxifloxacin 400mg po daily x 5-7 days.  \n-  COPD action plan template  \nPharmacological treatment for COPD  \nStable COPD management  \n1) IfFEV1 ≥ 80% predicted, few symptoms and no previous AECOPD:  \nPrescribe either LABA (formoterol, salmeterol) or LAMA (tiotropium, aclidinium, umeclidinium, glycopyrronium).  \n2) IfFEV1 \u003C80% predicted and stable COPD without exacerbations but patient has significant symptom burden:  \nPrescribe both LABA AND LAMA or a combination product with both ingredients.  \nIfFEV1 \u003C80% predicted and stable COPD without exacerbations but patient has significant symptom burden despite taking LAMA & LABA:  \nAdd inhaled steroid by switching to a LAMA/LABA/ICS combination puffer. In addition to triple inhaled therapy consider referring to pulmonary rehabilitation, which can improve symptoms considerably.  \nIfFEV1 \u003C 80% and the patient is taking LAMA/LABA/ICSand has had either 2 AECOPD within the last year or 1 AECOPD that sent them to the ER or to hospital admission:  \nAdd azithromycin 250mg OD (consider risk of hearing impairment and QT prolongation with arrythmias) .  \nInhaler examples  \nLABA examples: Salmeterol 50mcg 1 puff BiD (LU 391) or Oxeze (formoterol) 6mcg inhaled Bid or 12 mcg inhaled BiD  \nLAMA examples: Spiriva Respimat (tiotropium) 2.5 mcg 2 puffs OD or Tudorza (aclidinium) 400mcg BiD or Incruse (umeclidinium) 62.5 mcg 1 puff OD  \nCombination LAMA & LABA examples: Duaklir (aclidinium 400mcg and formoterol 12mcg) 1 puff BiD (LU 459) or Inspiolto (olodaterol 2.5mcg and tiotropium 2.5mcg)  \n2 puffs OD or Anoro (umeclidinium 62.5mcg and vilanterol 25mcg) 1 puff OD or Ultibro (glycopyrronium 50mcg and indacaterol 110mcg) 1 puff OD (all LU 459) .  \nCombination LABA/LAMA/ICS examples: Trelegy (fluticasone 100mcg/umeclidinium 62.5 mcg/vilanterol 25 mcg) 1 puff OD (LU 567) or Breztri (budesonide 160mcg/glycopyrronium 9mcg/formoterol 4.8 mcg) 2 puffs BiD (LU 638) .  \nCreated Date: 18-03-2024  \nAdvanced therapies  \nHome Oxygen Therapy  \nMortality benefit in patients with chronic hypoxia  \nOption 1  \nOxygen for maintenance use ≥ 15 hours/day  \n(i) PaO2 ≤ 55mmHg or  \n(ii) PaO2 56-59 mmHg but the patient has pulmonary hypertension or raised hematocrit.  \nSignificant improvement in exercise tolerance with  \nOption 2  \nOxygen ","cbCaib65HicxvCU7","https://ap.wps.com/l/cbCaib65HicxvCU7","pdf",481274,"English","# When to suspect COPD\n# Diagnosis and severity\n## Severity stratification by FEV1\n# Symptom assessment\n# Referral pathways\n# Preventative measures\n# COPD action plan for exacerbations\n# Pharmacological treatment for stable COPD\n## LABA/LAMA escalation to triple therapy\n# Advanced therapies\n## Home oxygen therapy\n# Palliative approaches and goals of care\n# Resources and smoking cessation","[{\"question\":\"When should clinicians suspect COPD?\",\"answer\":\"Suspect COPD with chronic and progressive dyspnea, recurrent wheeze, chronic cough, and recurrent respiratory infections, particularly with tobacco smoke exposure and other risk factors.\"},{\"question\":\"How is COPD diagnosed and confirmed?\",\"answer\":\"Diagnosis requires spirometry showing a post-bronchodilator FEV1/FVC ratio \\u003c0.7 (or LLN). If airflow obstruction is reversible with bronchodilators (FEV1 improves by ≥200 ml and ≥12%), asthma is more likely; if not reversible, COPD is confirmed.\"},{\"question\":\"What is the recommended approach for stable COPD medication escalation?\",\"answer\":\"Start based on FEV1 % predicted and symptom burden: FEV1 ≥80% with few symptoms and no prior exacerbations uses either LABA or LAMA; FEV1 \\u003c80% uses LABA plus LAMA (or a combination). If symptomatic despite dual therapy, switch to LAMA/LABA/ICS triple therapy, and consider add-on azithromycin for patients with recurrent exacerbations despite triple inhaled therapy.\"}]","COPD pathway - v2 - April 2026 | PDF",1790137206]