COPD and PE

Hey team:

We admit many cases of AECOPD on GIM, and many of our patients presenting with exacerbations are elderly.  Check this excellent article from JAMA on the care of older patients with COPD. Advance care planning in partnership with the patient and their family is key!

In patients where the etiology of the exacerbation is unclear, looking for PE is very important, as high as 25% of all presentations.  Decision making as to when and how to investigate is complex - many comorbidities are usually present.
 Here is an article discussing different investigations, and a useful decision tree (midway down the page).

Beta Blockers and COPD

Last week we discussed the use of beta blockers in COPD, and the fact that despite being 'relatively contraindicated' they should not be denied to those with COPD who might benefit from them.  Conditions for which beta blockade has a mortality benefit include heart  failure, and previous MI.  They also provide good anti anginal control in patients with CAD.  Their use in treating hypertension control is more nuanced, I will talk about it at a later post.

 This cochrane meta-analysis from 2005 summarized twenty studies on the use of cardioselective betablockers in COPD.  Note the attention to look at beta1 or cardioselective betablockers that have less effects on the bronchial beta 2 receptors.  The authors concluded that : "Cardioselective beta-blockers, given to patients with COPD in the identified studies did not produce adverse respiratory effects. Given their demonstrated benefit in conditions such as heart failure, coronary artery disease and hypertension, cardioselective beta-blockers should not be routinely withheld from patients with COPD."
For a more recent look at the interplay between COPD and Heart Failure treatment check out this review in JACC.