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How Can COPD Be Treated When The Elderly Patient Does Not Want To Go On Oxygen?
Question: Have COPD. BEING TREATED BY A PULMONALIST FOR ALMOST 4 years. Since NOV '16, I have had 6 treatments of antibiotics and 8 of steroids for this, to date. Dr. will not consider me for a regimen of some type of steroids and says I don't want or need to go on oxygen at this time. Have appt next TUES, 06 JUN, and I don't know how to approach him for changes I have been requesting for a year. I am presently on 3 Scripts and 2 OTC's for this and with minor adjustments, have been for 4 years. I am a 73 yr old male who is obese and single.w
Brief Answer:
Increase the dosage of the treatment
Detailed Answer:
Hello,
I can understand your concern
According to the history you provide last year you have had several COPD exacerbations ( 6 treatments of antibiotics and 8 of steroids) and you have COPD grade C or D??.
This is an indication for us that something is not going well.
The need for oxygen is indicated from arterial blood gases (ABG) results.
Usually if Sat O2 % is below 90% than the patient needs oxygen
However despite SatO2 the other values of ABG are very important to evaluate too in especially in COPD patients because high intake of oxygen are harmful for this lung diseases.
That*s why we (pulmonologists) should be very careful with the oxygen.
Probably your current COPD treatment should be more agressive (i mean to increase more the dose of the steroids inhalers).
If you were my patient i would recommend you inhalers with steroids+long acting bronchodilatators+long acting muscarinic agents (like inhaler Seretide puffs twice + inhaler Seebri puf once) and to lose weight too.
You can attach me an ABG result and we can discuss again
But please discuss with you doctor for the above because i am sure he/she knows better your actual clinical picture
Take care
Dr.Jolanda
Increase the dosage of the treatment
Detailed Answer:
Hello,
I can understand your concern
According to the history you provide last year you have had several COPD exacerbations ( 6 treatments of antibiotics and 8 of steroids) and you have COPD grade C or D??.
This is an indication for us that something is not going well.
The need for oxygen is indicated from arterial blood gases (ABG) results.
Usually if Sat O2 % is below 90% than the patient needs oxygen
However despite SatO2 the other values of ABG are very important to evaluate too in especially in COPD patients because high intake of oxygen are harmful for this lung diseases.
That*s why we (pulmonologists) should be very careful with the oxygen.
Probably your current COPD treatment should be more agressive (i mean to increase more the dose of the steroids inhalers).
If you were my patient i would recommend you inhalers with steroids+long acting bronchodilatators+long acting muscarinic agents (like inhaler Seretide puffs twice + inhaler Seebri puf once) and to lose weight too.
You can attach me an ABG result and we can discuss again
But please discuss with you doctor for the above because i am sure he/she knows better your actual clinical picture
Take care
Dr.Jolanda
Above answer was peer-reviewed by :
Dr. Nagamani Ng
Still waiting for your follow up on my follow up information. I was wondering if they might make a difference in your first answer.
Brief Answer:
Follow up
Detailed Answer:
Hi there
In my opinion as i explained, if you were my patient my follow up for you would be :
1.Increase the steroids dosage (inhalers)
2.Add in your inhalers Seebri once (it is an anticolinergic, if you have not it yet)
2.Depending on ABG results it will decide further about oxygen therapy (if needed or not)
You will feel better with the above
Wishes
Dr.Jolanda
Follow up
Detailed Answer:
Hi there
In my opinion as i explained, if you were my patient my follow up for you would be :
1.Increase the steroids dosage (inhalers)
2.Add in your inhalers Seebri once (it is an anticolinergic, if you have not it yet)
2.Depending on ABG results it will decide further about oxygen therapy (if needed or not)
You will feel better with the above
Wishes
Dr.Jolanda
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
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