Board Certification After Awhile

Was it worth it? I know many wonder this same question, and I believe it is. It is expensive to keep current. There is a yearly fee due to BPS every year. The required approved continuing education is pricey and complicated. 

The reason I continue to believe it is worth it is because prior to obtaining this, I feel like I had something to prove. Many newer grads felt or assumed I was a BS Pharm even though I was a PharmD. Many assume that because I have been out of school over 15 years, I am behind the times. Experience is sometimes not as valued in every job culture no matter what field it is. Bright and eager new graduates come out feeling as though we are behind the times, and sometimes they are right. 

Prior to obtaining my BCPS, I had no residency to point to. Yes, we had residencies back then, but my debt load didn't endorse another year of the same at half the price. The return on investment didn't seem good enough. If I was graduating today, I would definitely do a residency. 

What happened to me after the board certification is that I quit trying to prove myself to peers. I refocused my efforts on the patients by doing a better job in going the extra mile and also by noticing the system issues that aren't being exposed. I also have stopped trying to make my career the thing I work on the most and have let it fall to a healthier place behind God and family. What will be will be.  

Should a job in pharmacy open up where I can do more of the things I enjoy: clinical decision making, brainstorming, patient advocacy, and writing, I will be moved. Until then I credit certification to validating competiveness with newer pharmacists while also solidifying my belief that experience is king. I am glad I invested in myself and hope you will too! 

BCPS COPD: The Gold Guidelines (2013)

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The Gold Guidelines for the diagnosis and treatment of COPD are the gold standard for treating COPD.  

About Us
The Global Initiative for Chronic Obstructive Lung Disease (GOLD) works with health care professionals and public health officials around the world to raise awareness of Chronic Obstructive Pulmonary Disease (COPD) and to improve prevention and treatment of this lung disease.

Through the development of evidence-based guidelines for COPD management, and events such as the annual celebration of World COPD Day, GOLD is working to improve the lives of people with COPD in every corner of the globe.

Who Are We?
GOLD was launched in 1997 in collaboration with the National Heart, Lung, and Blood Institute, National Institutes of Health, USA, and the World Health Organization.

GOLD’s program is determined and its guidelines for COPD care are shaped by committees made up of leading experts from around the world.

COPD is an inflammatory response characterized by persistent airflow limitations that is progressive in nature.  Exacerbations and comorbidities contribute to the overall severity in patients.

Symptoms:  Dyspnea, chronic cough, chronic sputum production

Spirometry is required to make a clinical diagnosis of COPD; the presence of a post-bronchodilator FEV1/FVC < 0.70 confirms the presence of persistent airflow limitation and thus of COPD.

Causes:  Smoking, indoor air pollution, occupational dusts and chemicals, and outdoor air pollution

Differential Diagnosis:

  1. COPD:  Onset in mid-life.  Symptoms slowly progress.  Usually a history of smoking.
  2. Asthma:  Onset usually early in life.  Symptoms vary day-to-day.  Symptoms worse at night/morning.  Allergy, rhinitis, and/or eczema also present.  Family history.
  3. CHF:  Dilated heart, pulmonary edema on chest x-ray.  Pulmonary function tests show volume restriction, not airflow limitation.
  4. Bronchiectasis:  Usually associated with bacterial infection.  Lots of purulent sputum.  Chest x-ray/CT shows bronchial dilation and wall thickening.
  5. TB:  can confirm with microbiological testing.  Lung infiltrates.

The complete report (lengthy) can be found
www.goldcopd.org/uploads/users/files/GOLD_Report_2013_Feb20.pdf

The At A Glance COPD Management Refernce guide (short 8 pages)
www.goldcopd.org/uploads/users/files/GOLD_AtAGlance_2013_Feb20.pdf

The pocket guide (32 pages) for Health Care Professionals for Diagnosis, Management and Prevention is 
www.goldcopd.org/uploads/users/files/GOLD_Pocket_2013_Mar27.pdf

The GOLD classifications are the main method doctors use to describe the severity of chronic obstructive pulmonary disease (COPD).

GOLD is short for the Global Initiative for Chronic Obstructive Lung Disease, a collaboration between the National Institutes of Health and the World Health Organization.

What Is GOLD Staging for COPD?

The GOLD staging system classifies people with COPD based on their degree of airflow limitation (obstruction). The airflow limitation is measured during pulmonary function tests (PFTs).

When blowing out forcefully, people with normal lungs can exhale most of the air in their lungs in one second. Pulmonary function tests measure this and other values, and are used to diagnose COPD and its severity:

  • The volume in a one-second forced exhalation is called the forced expiratory volume in one second (FEV1), measured in liters.
  • The total exhaled breath is called the forced vital capacity (FVC), also measured in liters.
  • In people with normal lung function, FEV1 is at least 70% of FVC.

Because of lung damage, people with COPD take longer to blow air out. This impairment is called obstruction or airflow limitation. An FEV1 less than 70% of FVC can make the diagnosis of COPD in someone with compatible symptoms and history.

In GOLD COPD, classifications are then used to describe the severity of the obstruction or airflow limitation. The worse a person's airflow limitation is, the lower their FEV1. As COPD progresses, FEV1 tends to decline. GOLD COPD staging uses four categories of severity for COPD, based on the value of FEV1:

Stage I:  Mild COPD - FEV1/FVC<0.70 - FEV1 ≥ 80% normal

Stage II:  Moderate COPD - FEV1/FVC<0.70 - FEV1 50-79% normal

Stage III:  Severe COPD - FEV1/FVC<0.70 - FEV1 30-49% normal

Stage IV:  Very Severe COPD - FEV1/FVC<0.70 - FEV1 <30% normal, or <50% normal with chronic respiratory failure present*

* Usually, this means requiring long-term oxygen therapy.

What Do the GOLD COPD Classifications Mean?

The GOLD COPD criteria are an attempt by health experts to group people together based on the severity of their COPD. This process is called COPD staging. Accurate staging, or knowing the severity of your COPD, could have various benefits, such as:

  • Helping people with COPD understand their disease better
  • Helping doctors make better treatment recommendations for people with COPD
  • Helping people with COPD plan for their future, and predict life expectancy

The GOLD COPD staging system can be helpful toward these goals. But the system is not accurate or precise enough to predict symptoms or life expectancy in individual people living with COPD.

One problem is that the GOLD COPD classifications only consider a person's degree of airflow obstruction. On average, people with severe airflow obstruction from COPD do have worse symptoms and a shorter life expectancy than people with mild obstruction. However, many other factors beside airflow obstruction influence breathing symptoms and life expectancy, such as:

  • Overweight and obesity
  • Smoking status
  • Other medical conditions, especially heart disease
  • Physical fitness and exercise habits

Here is a guideline summary that is pretty in-depth.

Remember what you need to make a diagnosis:  spirometry.  Remember the categories.  Remember the treatments for each category.



Cholesterol Guideline Changes

A whopping 13 million more Americans will now be taking statins due to the recent changes in the guidelines formulated by the American Heart Association and the American College of Cardiology (source:  NEJM).  The new guidelines released by the American Heart Association were released back last November.  

The new guidelines are taking a very different approach.  Rather than focusing on specific end targets for cholesterol, the guidelines focus more on risk and prevention of strokes and heart attacks.  They disregard the guideline that doctors should prescribe cholesterol-lowering drugs when a patient's LDL, or bad cholesterol, reaches a certain threshold — in recent years, above 130.  The guidelines also say everyone with known heart disease should be taking statins.

The guideline recommends statin therapy for the following groups:

  • People without cardiovascular disease who are 40 to 75 years old and have a 7.5 percent or higher risk for having a heart attack or stroke within 10 years.  (According to a new risk calculator).
  • People with a history of a cardiovascular event (heart attack, stroke, stable or unstable angina, peripheral artery disease, transient ischemic attack, or coronary or other arterial revascularization).
  • People 21 and older who have a very high level of bad cholesterol (190 mg/dL or higher).
  • People with Type 1 or Type 2 diabetes who are 40 to 75 years old.  The drugs are also recommended for younger adults if their LDL cholesterol is over 190.

(Just for reference the old guidelines, using a different calculator, prescribed statin use at a 10-year risk above 20 percent, along with an LDL-cholesterol reading above 130).

As far as side effects go: