COPD Flashcards
In COPD airflow limitation is due to a combination of (?) (obstructive bronchiolitis) and parenchymal destruction (emphysema)
small airways disease
In COPD airflow limitation is due to a combination of small airways disease ((?)) and parenchymal destruction (emphysema)
obstructive bronchiolitis
In COPD airflow limitation is due to a combination of small airways disease (obstructive bronchiolitis) and (?) (emphysema)
parenchymal destruction
In COPD airflow limitation is due to a combination of small airways disease (obstructive bronchiolitis) and parenchymal destruction ((?))
emphysema
What are 5 complications of COPD?
Cor pulmonale Depression Anxiety Type 2 respiratory failure Secondary polycythaemia
What is the aim of COPD treatment?
To reduce symptoms and exacerbations and improve quality of life
COPD patients with excessive (?) should be taught active cycle of breathing techniques, and how to use positive expiratory pressure devices by a physiotherapist.
sputum production
COPD patients with excessive sputum production should be taught (?), and how to use positive expiratory pressure devices by a physiotherapist.
active cycle of breathing techniques
COPD patients with excessive sputum production should be taught active cycle of breathing techniques, and how to use (?) devices by a physiotherapist.
positive expiratory pressure
All COPD patients should be offered which two vaccines?
Pneumococcal vaccine
Annual influenza vaccine
In COPD patients, (?) treatment should be considered for patients with distressing or disabling breathlessness despite maximal use of inhalers, and continued if an improvement is seen in symptoms, ability to undertake activities of daily living, exercise capacity, or lung function.
nebulised
In COPD patients, nebulised treatment should be considered for patients with distressing or disabling breathlessness despite (?), and continued if an improvement is seen in symptoms, ability to undertake activities of daily living, exercise capacity, or lung function.
maximal use of inhalers
In COPD patients, nebulised treatment should be considered for patients with (?) despite maximal use of inhalers, and continued if an improvement is seen in symptoms, ability to undertake activities of daily living, exercise capacity, or lung function.
distressing or disabling breathlessness
What initial empirical inhaler treatment should be given to COPD patients?
A short-acting bronchodilator as required to relieve breathlessness and exercise limitation
Can be SABA or SAMA
A patient with COPD is currently being treated with a SABA as required but needs a step-up in management. They DO NOT have asthmatic features. What is the most appropriate next step in management?
LABA + LAMA
In patients who continue to be breathless or have exacerbations, offer a long-acting beta2 agonist (LABA) and a long-acting muscarinic antagonist (LAMA).
In the treatment of COPD, discontinue SAMA treatment if a (?) is given.
LAMA
Treatment with a SABA as required may be continued in all stages of COPD
In the treatment of COPD, discontinue (?) treatment if a LAMA is given.
SAMA
Treatment with a SABA as required may be continued in all stages of COPD
If a patient with COPD being treated with a LAMA and LABA has a severe exacerbation requiring hospitalisation, what should you consider adding to their management?
Inhaled corticosteroid (ICS)
If an ICS is given, review at least annually and document the reason for continuation.
If a patient with COPD being treated with a LAMA and LABA has at least two moderate exacerbations (requiring systemic corticosteroids and/or antibacterial treatment) within a year, what should you consider adding to their management?
Inhaled corticosteroid (ICS)
If an ICS is given, review at least annually and document the reason for continuation.
In patients on a LAMA and LABA whose day-to-day symptoms continue to adversely impact their quality of life, consider trialling the addition of an (?) for 3 months.
Inhaled corticosteroid (ICS)
If symptoms have improved, continue triple therapy and review at least annually. If there has been no improvement, step back down to a LAMA and LABA combination.
In patients on a LAMA and LABA whose day-to-day symptoms continue to adversely impact their quality of life, consider trialling the addition of an ICS for (?) months.
3 months
If symptoms have improved, continue triple therapy and review at least annually. If there has been no improvement, step back down to a LAMA and LABA combination.
A patient with COPD is currently being treated with a SABA as required but needs a step-up in management. They DO have asthmatic features. What is the most appropriate next step in management?
LABA + ICS
If an ICS is given, review annually documenting the reason for continuation.
If a patient with COPD being treated with a LABA and ICS has a severe exacerbation requiring hospitalisation, what should you add to their management?
LAMA
Discontinue SAMA treatment if a LAMA is given. Treatment with a SABA as required may be continued in all stages of COPD.
If a patient with COPD being treated with a LABA and ICS has at least two moderate exacerbations requiring systemic corticosteroids and/or antibacterial treatment within a year, what should you add to their management?
LAMA
Discontinue SAMA treatment if a LAMA is given. Treatment with a SABA as required may be continued in all stages of COPD.
If a patient with COPD being treated with a LABA and ICS continues to have day-to-day symptoms adversely impacting their quality of life, what should you add to their management?
LAMA
Discontinue SAMA treatment if a LAMA is given. Treatment with a SABA as required may be continued in all stages of COPD.
In the management of COPD, which antibiotic can you consider giving as prophylaxis to reduce the risk of exacerbations?
Azithromycin [unlicensed]
Review treatment after the first 3 months, then at least 6 monthly thereafter; only continue if benefits outweigh risks.
Which COPD patients would you consider giving azithromycin to as prophylaxis to reduce the risk of exacerbations? (need all three criteria)
- non-smokers
- all other treatments options optimised
- continue to either have prolonged or frequent (4 or more a year) exacerbations with sputum production or resulting in hospitalisation
What investigations should you do before giving prophylactic antibiotics (azithromycin) to COPD patients?
- Sputum culture and sensitivity testing
- CT scan of thorax (to rule out other lung pathologies)
- baseline ECG (QT prolongation?)
- LFTs
Name an add-on treatment to bronchodilator therapy that can be used in patients with severe COPD with chronic bronchitis (respiratory specialist initiation only)?
Roflumilast
Roflumilast is recommended as add-on treatment to bronchodilator therapy in patients with severe COPD with (?) (respiratory specialist initiation only)
chronic bronchitis
For COPD patients who have had an exacerbation within the last year, what should they keep at home? (2)
Short course of antibiotics
Oral corticosteroids
Antibiotics should be a non-macrolide if the patient is on prophylactic azithromycin
In the management of a COPD exacerbation, what non-drug treatment should be considered?
Physiotherapy using positive expiratory pressure devices to help with sputum clearance
In the management of COPD exacerbation consider physiotherapy using (?) devices to help with sputum clearance.
positive expiratory pressure
In the management of COPD exacerbation consider physiotherapy using positive expiratory pressure devices to help with (?).
sputum clearance
For the treatment of a COPD exacerbation give (?), usually at higher doses than the patient’s maintenance treatment through a nebuliser or hand-held device to manage breathlessness.
short-acting inhaled bronchodilators
For the treatment of a COPD exacerbation give short-acting inhaled bronchodilators, usually at higher doses than the patient’s maintenance treatment through a (?) or hand-held device to manage breathlessness.
nebuliser
For the treatment of a COPD exacerbation and in the absence of significant contraindications in patients that present to the hospital with an exacerbation, use a short course of (?) along with other therapies
prednisolone
Consider a short course of (?) for patients in the community experiencing a COPD exacerbation with a significant increase in breathlessness that interferes with daily activities.
prednisolone
Consider a short course of prednisolone for patients in the community experiencing a COPD exacerbation with a significant increase in (?) that interferes with daily activities.
breathlessness
What should you consider giving in a COPD patient who has frequent exacerbations requiring short courses of prednisolone?
Osteoporosis prophylaxis
In the treatment of a COPD exacerbation (?) should only be used as add-on treatment when there is an inadequate response to nebulised bronchodilators
Aminophylline
Ensure therapeutic drug monitoring is performed and that previous oral theophylline use is considered to avoid toxicity.
Theophylline is metabolised in the (?).
liver
Aminophylline is a stable mixture or combination of (?) and ethylenediamine; the ethylenediamine confers greater solubility in water.
theophylline
The plasma-theophylline concentration is increased in (1?), (2?), and in (3?)
- heart failure
- hepatic impairment
- viral infections
The plasma-theophylline concentration is decreased in (1?), and by (2?) consumption.
- smokers
2. alcohol
Aminophylline potentiates the (?) effects of beta-agonists
hypokalaemic
Particular caution is required in severe asthma, because this effect may be potentiated by concomitant treatment with theophylline and its derivatives, corticosteroids, and diuretics, and by hypoxia
Which electrolyte concentration do you need to monitor if using aminophylline in the treatment of severe asthma?
potassium
Aminophylline potentiates the hypokalaemic effects of beta-agonists
What are the signs and symptoms of theophylline overdose? (10)
Vomiting Agitation Restlessness Dilated pupils Sinus tachycardia Hyperglycaemia Haematemesis Convulsion Supraventricular and ventricular arrhythmias Severe hypokalaemia
What electrolyte abnormality would you see in a theophylline overdose?
Hypokalaemia
If you give a loading dose of IV aminophylline to a patient already taking theophylline, what do you need to monitor?
plasma-theophylline concentration
Serious side-effects such as convulsions and arrhythmias can occasionally precede other symptoms of toxicity.
If aminophylline is given intravenously, a blood sample should be taken (?) hours after starting treatment.
4-6 hours
If aminophylline is given orally, plasma-theophylline concentration is measured (?) days after starting oral treatment and at least 3 days after any dose adjustment.
5 days
BUT
A blood sample should usually be taken 4–6 hours after an oral dose of a modified-release preparation (sampling times may vary—consult local guidelines).
If aminophylline is given orally, plasma-theophylline concentration is measured 5 days after starting oral treatment and at least (?) days after any dose adjustment.
3 days
BUT
A blood sample should usually be taken 4–6 hours after an oral dose of a modified-release preparation (sampling times may vary—consult local guidelines).
What class of antibiotics is azithromycin?
macrolide
Macrolides may aggravate (disease?)
myasthenia gravis
Use IV macrolides with caution in patients with myasthenia gravis
Influenza vaccines protect people at high risk from influenza and reduce transmission of infection; the nasal spray contains (?) strains, all other vaccines are inactivated or produced by recombinant DNA technology.
live attentuated
Influenza vaccines protect people at high risk from influenza and reduce transmission of infection; the nasal spray contains live attenuated strains, all other vaccines are (?) or produced by recombinant DNA technology.
inactivated
Prednisolone exerts predominantly (glucocorticoid/mineralocorticoid? effects with minimal (glucocorticoid/mineralocorticoid?) effects.
Prednisolone exerts predominantly GLUCOCORTICOID effects with minimal MINERALOCORTICOID effects.
What needs to be monitored if using systemic prednisolone in a patient with systemic sclerosis?
Blood pressure Renal function (s-creatinine)
Increased incidence of scleroderma renal crisis
The use of systemic prednisolone in a patient with systemic sclerosis increases the incidence of (?)
scleroderma renal crisis
Monitor BP and renal function (s-creatinine)
(?) is a phosphodiesterase type-4 inhibitor with anti-inflammatory properties.
Roflumilast
Roflumilast is a (?) with anti-inflammatory properties.
phosphodiesterase type-4 inhibitor
Roflumilast is a phosphodiesterase type-4 inhibitor with (?) properties.
anti-inflammatory
(?) is indicated as an adjunct to bronchodilators for the maintenance treatment of patients with severe chronic obstructive pulmonary disease associated with chronic bronchitis and a history of frequent exacerbations
Roflumilast
Roflumilast is indicated as an adjunct to (?) for the maintenance treatment of patients with severe chronic obstructive pulmonary disease associated with chronic bronchitis and a history of frequent exacerbations
bronchodilators
Roflumilast is indicated as an adjunct to bronchodilators for the maintenance treatment of patients with severe chronic obstructive pulmonary disease associated with (?) and a history of frequent exacerbations
chronic bronchitis
Roflumilast is indicated as an adjunct to bronchodilators for the maintenance treatment of patients with severe chronic obstructive pulmonary disease associated with chronic bronchitis and a history of frequent (?)
exacerbations
