COPD

Question 1

Dx if someone has reversible airflow obstruction, is a smoker, and they start to devlop irreversible component to their obstruction

Answer 1

Asthma/COPD overlap Syndrome

Question 2

What Three tests should you get for a patient who you suspect has COPD

Answer 2

PFTs to make the diagnosis
Sleep study because Cpap if they have sleep apnea will decrease mortality and hospitalizations
(Can screen with STOP BANG)
Alpha 1 Antitrypsin

Question 3

What are the criteria to test for/ be suspicious of OSA

Answer 3

Snoring
Tired during the day 
Observed Apnea 
Pressure (being treated for HTN) 
BMI >35
Age ?50
Neck ?40 cm 
Gender Male

Question 4

Risks for COPD other than smoking

Answer 4

Alpha 1 antitrypsin
Second hand smoke
Immigrant patients living in enclosed places with burning biofuels
Female 
Air pollution 
Occupational Exposures 
Childhood infections

Question 5

What two scores can you use to grade COPD severity

Answer 5

mMRC

COPD Assessment Test

Question 6

What is the mMRC

Answer 6

Grade 0=Symptoms with strenuous exercise
Grade 1= Symptoms going quickly or up hill
Grade 2=Walk slower than people of your age because of symptoms
Grade 3=Cant go more than 100 m on flat ground
Grade 4=Unable to leave the house

Question 7

What categories are on the CAT

Answer 7

Sleep, energy, ADLS

Cough, Home confidence, Exercise (1 flight of stairs), sputum, Tightness in the chest,

SEA CHEST

0-5 for each

Question 8

Symptoms of COPD

Answer 8

Dyspnes
Cough
Sputum production
Wheeze

Question 9

What factors make it more likely that you will have future exacerbations of COPD

Answer 9

Past exacerbations

High eosinophil count

Question 10

Non pharm management (List 5)

Answer 10

Smoking cessation
Accupuncture 
Active mind-body therapy 
Yoga
Tai Chi
Pulmonary rehab

O2-but this doesn’t change hospitalization or time to death (? can have survival advantage if PaO2 <55)

Question 11

Important preventative measures in COPD patients

Answer 11

Smoking cessation
Influenza vaccine
Pneumonia vaccine

Question 12

How to treat someone with COPD

Answer 12

MMRC and CAT and how many exacerbations
Ventolin (Short Acting Beta 2 Agonist) if low symptoms and no exacerbations
Spiriva (Long Acting Muscarinic Antagonist) if low symptoms but some exacerbations
Spiriva (LAMA) if higher symptoms but no exacerbations
Spiriva (LAMA) Or Onbreze (Long Acting Beta 2 Agonist) OR Anoro (Combo LAMA/LABA)
Add ICS IF High eosinophils (300)

Question 13

When should you use an ICS in COPD

Answer 13

Eosinophils >300

Question 14

When should you avoid an ICS in COPD

Answer 14

Eosinophils <100
Frequent pneumonias
History of mycobacterium

Question 15

What could you consider if someone has frequent exacerbations

Answer 15

Adding daily macrolide (azithromycin)

Question 16

What could you consider if someone has frequent hospitalizations

Answer 16

Create action plan
Use SABA
Initiate Pred 40 mg po daily x 5 days
Start Amox if simple or Moxifloxacin if complicated

Question 17

Who can you refer to

Answer 17

Pulmonary rehab
Resp therapy
Smoking cessation
Palliative care

Question 18

What ABX to use in exacerbation

Answer 18

Simple:
Amoxicillin 500 mg tid x 7 days if simple
Doxycycline
2nd line=Azithromycin

Complicated:
Amoxi/clav
2nd line=Moxifloxacin 400 mg po x 5 days if (on ICS, recent antibiotic use, on oxygen, >3 COPDE in the past year, or FEV1 <50%)

Pseudomonas (If on ICS think about this)
Cipro

TREAT PER LOCAL RESISTANCE PATTERNS

Question 19

When to use moxifloxacin (quinolone) for COPDE

Answer 19

ABX recently 
On ICS
On O2
More than 3 COPDE in the past year 
FEV1 <50%

Question 20

List two benefits and one risk of adding triple therapy in COPD

Answer 20

Mortality benefit
Fewer exacerbations
More pneumonia

Question 21

When to give abx.

Answer 21

Winnepeg criteria 
2/3 of 
1. Sputum purulence
2. Sputum volume 
3. Dyspnea 

OR

CRP>40

Question 22

What bacteria are likely to cause a COPDE

Answer 22

H. Influenza
S. Pneumoniae
M. Catarrhalis

Klebsiella
Pseudomonas

Question 23

Criteria for diagnosing COPD

Answer 23

FEV1/FVC <0.7