question.

Common Diagnoses Necessitating Palliative Care Referral by Nurse Practitioner

Signs/Symptoms

Gold Standard Diagnostics

Gold Standard Treatment

Ex: COPD

Chronic cough, chronic sputum production, shortness of breath worse with physical exertion, progressive symptoms, barrel chest, weight loss; hyperresonance upon percussion, tactile fremitus and egophony is decreased; CXR may show hyperinflation; bullae sometimes present; coarse crackles.

Refer to GOLD Report – Global Initiative for Chronic Obstructive Lung Disease.

A diagnosis of COPD should be considered in any patient who has dyspnea, chronic cough or sputum production, a history of recurrent lower respiratory tract infections and/or a history of exposure to risk factors for the disease, but forced spirometry showing the presence of a postbronchodilator FEV1/FVC < 0.7 is mandatory to establish the diagnosis of COPD.

Prevention and Maintenance Therapy: Smoking cessation, Vaccination (pneumonia, influenza, COVID-19, Tdap).

Acute exacerbation: SABA (albuterol, levalbuterol). SAMA (Ipratropium bromide) often used in combination with SABA. While continuation of ongoing therapy with long-acting beta agonists (LABAs) or LAMAs has not been specifically studied, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy advises their continuation. Oral Glucocorticoid therapy: 40mg per day for 5-14 days

Antibiotic Therapy: the GOLD strategy recommends empiric antibiotics for patients with COPD exacerbations who have increased sputum purulence and either increased sputum volume or increased dyspnea, or for patients who require ventilatory assistance.

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