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Chronic obstructive pulmonary disease - Management
How should I manage a person with cor pulmonale?
- Consider the possibility of other causes of peripheral oedema, including congestive heart failure and chronic thromboembolic disease.
- If cor pulmonale is the most likely diagnosis, refer the person to a respiratory specialist for assessment for the need for long-term oxygen therapy (if not recently assessed, or already receiving it), confirmation of the diagnosis, and optimization of medical therapy.
- If necessary, treat oedema symptomatically with a diuretic, for example furosemide 20 mg once daily, increasing if necessary to 40 mg once daily.
- Check serum electrolytes soon after starting or increasing the dose.
- The following should not be used to treat cor pulmonale, but may be used for other indications.
- Angiotensin-converting enzyme inhibitors.
- Calcium-channel blockers.
- Alpha-blockers.
- Digoxin (unless there is atrial fibrillation).
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