42. COPD Flashcards

1
Q

COPD is most commonly caused by ___ =, but can be caused by other air pollutants

A

tobacco smoke

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2
Q

____ is the destruction of the small passages in the lungs (alveoli)

A

Emphysema

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3
Q

____ is the inflammation and narrowing of the bronchial tubes (results in mucus production and chronic cough)

A

Bronchitis

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4
Q

Pts with ____ deficiency are at a higher risk of developing COPD

A

Alpha-1 antitrypsin (AAT)
Note: AAT helps protect lungs from damage caused by inflammation

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5
Q

T/F: In COPD, the limitation of airflow is fully reversible with treatment

A

False - not fully reversible and progresses over time, leading to gradual loss of lung function

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6
Q

A post-bronchodilator FEV1/FBC < ____ confirms a dx of COPD

A

0.70

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7
Q

Which guidelines are used for COPD treatment?

A

GOLD

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8
Q

Predicted FEV1 for GOLD 1 (Mild) COPD

A

FEV1 ≥ 80%

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9
Q

Predicted FEV1 for GOLD 2 (Moderate) COPD

A

50% ≤ FEV1 < 80%

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10
Q

Predicted FEV1 for GOLD 3 (Severe) COPD

A

30% ≤ FEV1 < 50%

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11
Q

Predicted FEV1 for GOLD 4 (Very Severe) COPD

A

FEV1 < 30%

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12
Q

What are the two most commonly used symptom assessment scoring systems?

A

Modified British Medical Research Council (mMRC) dyspnea scale
COPD Assessment Test (CAT)

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13
Q

mMRC dyspnea scale assesses _____ whereas the CAT is a ___

A

breathlessness
comprehensive assessment of symptoms (e.g. cough, mucus, production, chest tightness, energy level, breathlessness, sleep patterns, limitations to normal activity)

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14
Q

Define COPD exacerbation

A

Increase in respiratory symptoms that worsen over < 14 days

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15
Q

Hospitalization for COPD exacerbation is a/w increased risk of ___

A

death

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16
Q

If a patient has __ or more exacerbations per year, they are considered to be frequent exacerbators

A

2 or more

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17
Q

Define COPD group A:
CAT score ___
mMRC score ____
Exacerbations ____

A

CAT <10
mMRC 0-1
0-1 moderate exacerbations (no hospitalization)

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18
Q

Define COPD group B:
CAT score ___
mMRC score ____
Exacerbations ___

A

CAT ≥10
mMRC ≥ 2
0-1 moderate exacerbations (no hospitalization)

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19
Q

Define COPD group E:
CAT score ___
mMRC score ____
Exacerbations ___

A

≥ 2 moderate exacerbations or ≥ 1 hospitalization d/t exacerbations

regardless of CAT/mMRC scores

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20
Q

Vaccine recommendation for COPD pts

A

Annual influenza, pneumococcal vaccines and Tdap

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21
Q

___ is the only non-drug management strategy proven to slow progression of COPD

A

Smoking cessation

22
Q

____ are first-line treatment for all COPD pts

A

Bronchodilators

23
Q

ICS are recommended in select pts with hx of exacerbations and eosinophil counts (marker of inflammation) ≥ _____ cells/µL

A

≥300

Note: not recommended in pts with lower eosinophil counts (<100), no demonstrated benefit

24
Q

Initial pharmacologic therapy for COPD: Group A

A

Bronchodilator (SAMA prn, SABA prn, LAMA or LABA)

25
Q

Initial pharmacologic therapy for COPD: Group B

A

LAMA + LABA

26
Q

Initial pharmacologic therapy for COPD: Group E

A

LAMAB + LABA
If blood eosinophils ≥ 300, consider LAMA+LABA+ICS

27
Q

Consider ___ or ___ if exacerbations occur despite LAMA+LABA or LAMA+LABA+ICS regimen

A

Roflumilast or azithromycin

28
Q

If there is increased __, ___, or ____ , or if ___ is required, antibiotics should be used

A

Sputum purulence, sputum volume, dyspnea
Mechanical ventilation

29
Q

Muscarinic antagonists MOA

A

Bronchodilation by blocking the constricting action of ACh at M3 muscarinic receptors in bronchial smooth muscle

30
Q

Ipratropium (Atrovent HFA) COPD dosing

A

MDI: 2 inhalations QID

31
Q

Ipratropium/albuterol (Combivent Respimat) COPD dosing

A

MDI: 1 inhalation QID

32
Q

Examples of SAMAs used in COPD

A

Ipratropium (Atrovent HFA)
Ipratropium/albuterol (Combivent Respimat)

33
Q

Examples of LAMAs used in COPD

A

Tiotropium (Spiriva HandiHaler, Spiriva Respimat)
Glycopyrrolate/Formoterol/Budesonide (Breztri Aerosphere)
Umeclidinium (Incruse Ellipta)
Umeclidinium/vilanterol/fluticasone (Trelegy Ellipta)
Aclidinium (Tudorza Pressair)

34
Q

___ devices are DPIs that come with a capsule that is placed into the device; do NOT swallow the capsules by mouth

A

HandiHaler

35
Q

___ devices are DPIs that have an indicator window that turns from green to red if the dose was inhaled properly

A

Pressair

36
Q

Side effects for muscarinic antagonists COPD

A

Dry mouth
Others: URTI, cough, bitter tastte

37
Q

Tiotropium (Spiriva HandiHaler) COPD dosing

A

DPI: Inhale contents of 1 capsule via HandiHaler device daily (Requires 2 puffs)

38
Q

Tiotropium (Spiriba Respimat) COPD dosing

A

MDI: 2 inhalations daily

39
Q

Aclidinium (Tudorza Pressair) COPD dosing

A

DPI: 1 inhalation BID

40
Q

Umeclidinium (Incruse Ellipta) COPD dosing

A

DPI: 1 inhalation daily

41
Q

Beta-2 agonist MOA

A

Bind to beta-2 receptors in lung, causing relaxation of bronchial smooth muscle and bronchodilation

42
Q

T/F: LABAs can be used as monotherapy for COPD but not asthma

A

True - boxed warning for increased risk of asthma-related deaths when used as monotherapy

43
Q

Side effects of beta-2 agonists COPD

A

Nervousness, tremor, tachycardia, palpitations, hyperglycemia, decreased K, cough

44
Q

____ contains the R-isomer of formoterol

A

Arformoterol

45
Q

Salmeterole (Serevent Diskus) COPD dosing

A

DPI: 1 inhalation BID

46
Q

Formoterol/Budesonide (Symbicort) COPD dosing

A

MDI: 2 inhalations BID

47
Q

Vilanterol/Fluticasone (Breo Ellipta) COPD dosing

A

DPI: 1 inhalation daily

48
Q

Examples of LABAs used in COPD

A

Salmeterol (Serevent Diskus)
Salmeterol/fluticasone (Advair Diskus)
Formoterol (Perforomist)
Formoterol/budesonide (Symbicort)
Formoterol/gylcopyrrolate/budesonide (Bretztri Aerosphere)
Vilanterol/fluticasone (Breo Ellipta)
Vilanterol/umeclidinium/fluticasone (Trelegy Ellipta)

49
Q

___ is a PDE-4i that increases cAMP levels, leading to a reduction in lung inflammation

A

Roflumilast (Daliresp)

50
Q

Contraindications for Roflumilast (Daliresp)

A

Moderate to severe liver impairment

51
Q

Side effects for Roflumilast (Daliresp)

A

Diarrhea, weight loss
Others: nausea, decreased appetite, insomnia, HA

52
Q

T/F: You need to shake Atrovent HFA before use

A

False - you do not have to shake