Chronic COPD- Picking Therapy Flashcards
Mainstay of COPD treatment
Bronchodilators
What formulation of bronchodilators is more convenient and more effective at producing maintained symptom relief
Long-acting
Bronchodilator dose-response curve
Relatively flat; toxicity is also dose-related
This is why the LABA dose stays constant but the ICS dose changes in combo products
Theophylline isn’t recommended unless what happens?
Other long-term bronchodilators aren’t affordable/available
Strong support to use an ICS in COPD treatment
History of hospitalization(s) for exacerbations of COPD despite long-term appropriate LA bronchodilator treatment
≥2 moderate exacerbations of COPD per year despite long-term appropriate LA bronchodilator treatment
Eosinophils ≥300 cells/ul
History of, or concomitant asthma
Consider ICS use in these COPD patients
1 moderate exacerbation of COPD per year despite long-term appropriate LA bronchodilator treatment
Eosinophils ≥100 to <300 cells/ul
Evidence against ICS use in COPD
Repeated pneumonia events
Eosinophils <100 cells/ul
History of mycobacterial infection
Nonpharm options for COPD
Smoking cessation
Vaccinations (flu, Tdap, COVID, pneumococcal)
Pulmonary rehab
Long-term O2 therapy
Surgery, lung transplantation in select severe COPD patients
Other pharmacologic treatments
ABX, mucolytics/antioxidant agents, antitussives
ABX indication in COPD
Treatment of infectious exacerbations of COPD and other bacterial infections
Mucolytics/antioxidant agents used in COPD
Guaifenesin, carbocysteine, N-acetylcysteine
NOT recommended in the guidelines
Antitussives in COPD
Not recommended because cough has a protective role in COPD
