COPD

Question 1

ABC of COPD

Answer 1

Age >40 years
Breathing or dyspnea is: progressive (worsens over time), worsens with exercise, persistent
Chronic cough

Question 2

Indicators of COPD diagnosis

Answer 2

• chronic sputum production
• tobacco smoke
• indoor pollution
• occupational dusts and chemicals
• family history of copd

Question 3

spirometry results

Answer 3

fev1/fvc <0.70 confirms persistent airflow limitation

Question 4

symptoms assessment for copd

Answer 4

• copd assessment test (cat)
• modified british medical research council (mmrc) breathlessness scale
• degree of airflow limitation

Question 5

gold grading

Answer 5

gold 1, mild: fev >/= 80% predicted
gold 2, moderate 50% < fev1 < 80%
gold 3, severe 30 < fev1 < 50%
gold 4, very severe fev1 < 30%

Question 6

risk assessment for exacerbations

Answer 6

abcd assessment tool read!!

Question 7

moa of bronchodilators

Answer 7

• b2 agonist: stimulate b2 receptors to relax airway smooth muscle
• anticholinergics: blocks effect of acetylcholine on m3 receptors to relax smooth muscle
• methylxanthines: unknown moa

Question 8

initial treatments by group

Answer 8

group a: bronchodilator
group b: laba or lama
group c: lama
group d: lama or lama + laba or ics + laba

Question 9

what are sabas

Answer 9

• salbutamol and fenoterol
• fast onset with 4 to6 hour duration
• sedating

Question 10

what are twice a day labas

Answer 10

• salmeterol, formoterol

- 12 hr duration

Question 11

ultra once a day labas

Answer 11

• indacaterol, olodaterol, vilanterol, abediterol
• very fast acting, longer than 24 hour duration
• once daily dosing gets better adherence

Question 12

what are lama/laba fixed dose combinations

Answer 12

• benefits of both laba and lama

lama: tiotropium, glycopyrronium, umeclidinium, aclidinium

Question 13

lama/laba combinations

Answer 13

• glycopyrronium/ indacaterol
• umeclidinium/ vilanterol
• tiotropium/ olodaterol
• aclidinium/ formoterol
• glycopyrronium bromide/ formoterol

Question 14

benefits of laba/lama

Answer 14

• better compliance
• greater improvements
• lower risk of side effects

Question 15

considerations for corticosteroids

Answer 15

• long term monotherapy with ics not recommended
• long term oral steroids not recommended
• long term ics + laba can be considered for severe

Question 16

considerations for pde-4 inhibitors

Answer 16

• roflumilast can reduce exacerbations for pts w: chronic bronchitis, severe/very severe airflow limitation, frequent exacerbations
• theophylline is a nonselective pde inhibitor

Question 17

considerations for anti-inflammatory agents

Answer 17

• macrolides for former smokers with exacerbations

- antioxidant mucolytics for some patients

Question 18

strong support to start ics treatment

Answer 18

• history of hospitalization/s for exacerbations of copd
• two or more moderate exacerbations of copd per year
• blood eosinophils > 300 cells/mcL
• history or concomitant asthma

Question 19

consider use ics treatment

Answer 19

• 1 moderate exacerbation of copd per year

- blood eosinophils 100-300 cells/mcL

Question 20

against use ics treatment

Answer 20

• repeated pneumonia events
• blood eosinophils <100 cells/mcL
• histroy of mycobacterial infection

Question 21

follow up pharmacological treatment

Answer 21

read