Arfoosh: Pulmonary Obstructive Lung Disease (COPD)

Question 1

What is the key difference between COPD and asthma?

Answer 1

In COPD, airflow limitation is PERSISTENT

Question 2

What is required to make a dx of COPD?

Answer 2

SPIROMETRY. take at least 3 measurements in consideration of dx.
FEV1/FVC confirms COPD

Question 3

Describe the 4 levels of classification of severity of airflow limitation in COPD.

Answer 3

GOLD 1: Mild (FEV >80%)
GOLD 2: Moderate (FEV b/t 50-80%)
GOLD 3: Severe (FEV b/t 30-50%)
GOLD 4: Very Severe (FEV

Question 4

What defines high risk of exacerbations in a COPD patient?

Answer 4

Use hx of exacerbations and spirometry to assess.

High risk = 2+ exacerbations w/in last year OR FEV1

Question 5

***Describe the 4 levels (A-D) of the combined assessment of COPD patients.

***List the medications for each category.

Answer 5

A: Low risk/Low sx; GOLD 1-2
B: Low Risk/MORE sx; GOLD 1-2
C: HIGH risk/low sx; GOLD 3-4 (>or=2 exacerbations/yr)
D: HIGH RISK/MORE sx; GOLD 3-4 (>or=2 exacerbations/yr)

MEDS:
A: SAMA or SABA prn
B: LAMA or PABA
C: ICS + LABA or LAMA
D: ICS + LABA and/or LAMA

Question 6

What test will you perform on your patient who has been dx’d with COPD at a young age (under 45)?

Answer 6

Alpha-1 Antitrypsin deficiency

Question 7

**What two things can you tell your patients to do that will help them live longer with COPD?

Answer 7

1. Quit smoking
2. Use O2 (15h/day) (see qualifying criteria question card)

(no existing medications for COPD have been shown conclusively to modify the long-term decline in lung function.)

Question 8

Is ICS one of the top therapeutic agents in COPD?

Answer 8

No, but it is in asthma.

ICS is reserved for more severe patients, but it also comes with a higher risk of pneumonia. (FEV1

Question 9

What are the top therapeutic options in treatment of COPD?

Answer 9

Bronchodilator medications

• Beta2 agonists
• anticholinergics
• theophylline
• combination therapy
• LABAs more effective than SABAs
• Severe and very severe (GOLD 3 & 4) & hx of CHRONIC BRONCHITIS & hx of EXACERBATIONS:
• Roflumilast

Question 10

Is the use of antibiotics indicated in COPD patients? (other than for treating infectious exacerbations and other bacterial infections)

Answer 10

No.

Question 11

What is the qualifying criteria for putting a patient on supplemental O2?

Answer 11

• PO2 56%

Question 12

What defines an exacerbation of COPD?

Answer 12

worsening of sx that leads to a CHANGE IN MEDS

Question 13

When treating an episode of exacerbation in a COPD patient, to what level should you titrate the supplemental O2?

Answer 13

88-92%

Question 14

***What treatment can you give in a hospital setting to a patient experiencing an acute exacerbation of COPD that will decrease mortality and needs for intubation?

Answer 14

NIV (non-invasive ventilation).

Also: it improves respiratory acidosis, decreases RR and severity of SOB, decreases complications and length of hospital stay

Question 15

What class of drugs can be considered in palliative care of a patient with COPD?

Answer 15

opiates (except benzodiazepines)