42. COPD Flashcards
COPD is most commonly caused by ___ =, but can be caused by other air pollutants
tobacco smoke
____ is the destruction of the small passages in the lungs (alveoli)
Emphysema
____ is the inflammation and narrowing of the bronchial tubes (results in mucus production and chronic cough)
Bronchitis
Pts with ____ deficiency are at a higher risk of developing COPD
Alpha-1 antitrypsin (AAT)
Note: AAT helps protect lungs from damage caused by inflammation
T/F: In COPD, the limitation of airflow is fully reversible with treatment
False - not fully reversible and progresses over time, leading to gradual loss of lung function
A post-bronchodilator FEV1/FBC < ____ confirms a dx of COPD
0.70
Which guidelines are used for COPD treatment?
GOLD
Predicted FEV1 for GOLD 1 (Mild) COPD
FEV1 ≥ 80%
Predicted FEV1 for GOLD 2 (Moderate) COPD
50% ≤ FEV1 < 80%
Predicted FEV1 for GOLD 3 (Severe) COPD
30% ≤ FEV1 < 50%
Predicted FEV1 for GOLD 4 (Very Severe) COPD
FEV1 < 30%
What are the two most commonly used symptom assessment scoring systems?
Modified British Medical Research Council (mMRC) dyspnea scale
COPD Assessment Test (CAT)
mMRC dyspnea scale assesses _____ whereas the CAT is a ___
breathlessness
comprehensive assessment of symptoms (e.g. cough, mucus, production, chest tightness, energy level, breathlessness, sleep patterns, limitations to normal activity)
Define COPD exacerbation
Increase in respiratory symptoms that worsen over < 14 days
Hospitalization for COPD exacerbation is a/w increased risk of ___
death
If a patient has __ or more exacerbations per year, they are considered to be frequent exacerbators
2 or more
Define COPD group A:
CAT score ___
mMRC score ____
Exacerbations ____
CAT <10
mMRC 0-1
0-1 moderate exacerbations (no hospitalization)
Define COPD group B:
CAT score ___
mMRC score ____
Exacerbations ___
CAT ≥10
mMRC ≥ 2
0-1 moderate exacerbations (no hospitalization)
Define COPD group E:
CAT score ___
mMRC score ____
Exacerbations ___
≥ 2 moderate exacerbations or ≥ 1 hospitalization d/t exacerbations
regardless of CAT/mMRC scores
Vaccine recommendation for COPD pts
Annual influenza, pneumococcal vaccines and Tdap
___ is the only non-drug management strategy proven to slow progression of COPD
Smoking cessation
____ are first-line treatment for all COPD pts
Bronchodilators
ICS are recommended in select pts with hx of exacerbations and eosinophil counts (marker of inflammation) ≥ _____ cells/µL
≥300
Note: not recommended in pts with lower eosinophil counts (<100), no demonstrated benefit
Initial pharmacologic therapy for COPD: Group A
Bronchodilator (SAMA prn, SABA prn, LAMA or LABA)
Initial pharmacologic therapy for COPD: Group B
LAMA + LABA
Initial pharmacologic therapy for COPD: Group E
LAMAB + LABA
If blood eosinophils ≥ 300, consider LAMA+LABA+ICS
Consider ___ or ___ if exacerbations occur despite LAMA+LABA or LAMA+LABA+ICS regimen
Roflumilast or azithromycin
If there is increased __, ___, or ____ , or if ___ is required, antibiotics should be used
Sputum purulence, sputum volume, dyspnea
Mechanical ventilation
Muscarinic antagonists MOA
Bronchodilation by blocking the constricting action of ACh at M3 muscarinic receptors in bronchial smooth muscle
Ipratropium (Atrovent HFA) COPD dosing
MDI: 2 inhalations QID
Ipratropium/albuterol (Combivent Respimat) COPD dosing
MDI: 1 inhalation QID
Examples of SAMAs used in COPD
Ipratropium (Atrovent HFA)
Ipratropium/albuterol (Combivent Respimat)
Examples of LAMAs used in COPD
Tiotropium (Spiriva HandiHaler, Spiriva Respimat)
Glycopyrrolate/Formoterol/Budesonide (Breztri Aerosphere)
Umeclidinium (Incruse Ellipta)
Umeclidinium/vilanterol/fluticasone (Trelegy Ellipta)
Aclidinium (Tudorza Pressair)
___ devices are DPIs that come with a capsule that is placed into the device; do NOT swallow the capsules by mouth
HandiHaler
___ devices are DPIs that have an indicator window that turns from green to red if the dose was inhaled properly
Pressair
Side effects for muscarinic antagonists COPD
Dry mouth
Others: URTI, cough, bitter tastte
Tiotropium (Spiriva HandiHaler) COPD dosing
DPI: Inhale contents of 1 capsule via HandiHaler device daily (Requires 2 puffs)
Tiotropium (Spiriba Respimat) COPD dosing
MDI: 2 inhalations daily
Aclidinium (Tudorza Pressair) COPD dosing
DPI: 1 inhalation BID
Umeclidinium (Incruse Ellipta) COPD dosing
DPI: 1 inhalation daily
Beta-2 agonist MOA
Bind to beta-2 receptors in lung, causing relaxation of bronchial smooth muscle and bronchodilation
T/F: LABAs can be used as monotherapy for COPD but not asthma
True - boxed warning for increased risk of asthma-related deaths when used as monotherapy
Side effects of beta-2 agonists COPD
Nervousness, tremor, tachycardia, palpitations, hyperglycemia, decreased K, cough
____ contains the R-isomer of formoterol
Arformoterol
Salmeterole (Serevent Diskus) COPD dosing
DPI: 1 inhalation BID
Formoterol/Budesonide (Symbicort) COPD dosing
MDI: 2 inhalations BID
Vilanterol/Fluticasone (Breo Ellipta) COPD dosing
DPI: 1 inhalation daily
Examples of LABAs used in COPD
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)
___ is a PDE-4i that increases cAMP levels, leading to a reduction in lung inflammation
Roflumilast (Daliresp)
Contraindications for Roflumilast (Daliresp)
Moderate to severe liver impairment
Side effects for Roflumilast (Daliresp)
Diarrhea, weight loss
Others: nausea, decreased appetite, insomnia, HA
T/F: You need to shake Atrovent HFA before use
False - you do not have to shake
