Chapter 35: COPD

Question 1

Brand name of ipratropium bromide?

Answer 1

Atrovent® HFA

This is a SA anticholinergic used in the treatment of COPD. Typical dose of Atrovent® is 2 inhalations QID.

Question 2

Brand name of ipratropium + albuterol?

Answer 2

Combivent Respimat®, Duoneb®

This is a combination of SA anticholinergic + SABA used in the treatment of COPD. Typical dose of Combivent® is 1 inhalation QID.

Question 3

Brand name of Aclidinium?

Answer 3

Tudorza Pressair®

This is a LA anticholinergic used in the treatment of COPD. Typical dose is 1 inhalation BID.

Question 4

Brand name of glycopyrrolate?

Answer 4

Seebri Neohaler®

This is a LA anticholinergic used in the treatment of COPD. Typical dose is 1 capsule BID.

Question 5

Brand name of indacaterol?

Answer 5

Arcapta Neohaler®

This is a LABA used in the treatment of COPD. Typical dose of Arcapta Neohaler® is 1 capsule daily. Each capsule contains 75mcg indacaterol.

Question 6

Brand name of glycopyrrolate + indacaterol?

Answer 6

Utibron Neohaler®

This is a combination of LA anticholinergic + LABA used in the treatment of COPD. Typical dose of Utibron Neohaler® is 1 capsule BID.

Question 7

Brand name of tiotropium?

Answer 7

Spiriva Handihaler®; Spiriva Respimat®

This is a LA anticholinergic used in the treatment of COPD. Typical dose is inhale 1 capsule daily (requires 2 puffs from same capsule)

Question 8

Brand name of olodaterol?

Answer 8

Striverdi Respimat®

This is a LABA used in the treatment of COPD. Typical dose is 2 inhalations daily.

Question 9

Brand name of tiotropium + olodaterol?

Answer 9

Stiolto Respimat®

This is a combination LA anticholinergic + LABA used in the treatment of COPD. Typical dose is 2 inhalations daily.

Question 10

Brand name of umeclidinium?

Answer 10

Incruse Ellipta®

This is a LA anticholinergic used in the treatment of COPD. Typical dose is 1 inhalation daily.

Question 11

Brand name of umeclidinium + vilanterol?

Answer 11

Anoro Ellipta®

This is a LA anticholinergic + LABA used in the treatment of COPD. Typical dose is 1 inhalation daily.

Question 12

Brand name of Arformoterol?

Answer 12

Brovana®

This is a LABA used in the treatment of COPD. It contains the R-isomer of formoterol. Typical dose is nebulize 15mcg BID

Question 13

Brand name of fluticasone + vilanterol?

Answer 13

Breo Ellipta®

This is an ICS + LABA used in the treatment of COPD. Typical dose is 1 inhalation daily.

Question 14

Brand name of roflumilast?

Answer 14

Daliresp®

This is a PDE-4 inhibitor used in the treatment of COPD. Inhibition of phosphodiesterase-4 increases cAMP levels leading to a reduction in lung inflammation. This medication should always be used in combination with at least one other long-acting bronchodilator. Typical dose is 500mcg PO daily - it is NOT an inhaled medication. CI in liver impairment and warning for suicidality. Major 3A4 substrate.

Question 15

What is the only proven non-pharmacologic management strategy for COPD patients to slow the progression of disease?

Answer 15

Smoking cessation

Question 16

Which of the following statements regarding COPD is correct? (Select all that apply)

A. COPD medications can modify long-term decline in lung function
B. ICS are often used monotherapy in patients with COPD
C. Take glycopyrrolate capsules with a full glass of water and a small snack
D. Daliresp® is an appropriate medication to start in patients with mild-moderate COPD
E. Using the Spiriva Handihaler® requires inhaling twice for one capsule

Answer 16

E is the only correct statement here.
Patients must be instructed to load Spiriva® capsule into handihaler, inhale…then inhale again from the same capsule in order to get the full dose.

A, B, C, and D are incorrect.
COPD medications have NOT been shown to modify long-term decline in lung function, nor reduce mortality. Long-term monotherapy with ICS is not recommended and should be used as adjunct therapy. Glycopyrrolate (Seebri Neohaler®) capsules are used similar to Spiriva® handihaler in which they are placed into the inhaler, punctured, then inhaled. Seebri® capsules should never be swallowed, they are inhaled using the neohaler device. Roflumilast (Daliresp®) is a PDE-4 inhibitor used only in severe COPD patients and would not be appropriate for patients with mild-moderate COPD since there are more effective medications available.