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Asthma/Allergic Rhinitis/COPD > COPD > Flashcards

COPD Flashcards

1
Q

COPD

A

preventable and treatable disease that is characterized by persistent respiratory symptoms and airflow limitation usually caused by significant exposure to noxious particles or gases

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2
Q

Risk factors for COPD

A

-smoking
-occupational dust and chemicals
-indoor/outdoor pollution
-genes
-infections
-socio-economic status
-aging population

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3
Q

Clinical Presentation of COPD

A

-Dyspnea
-Cough (often first sx of COPD) - intermittent or persistent; productive or unproductive
-Chronic sputum production
-Wheezing
-Comorbidities

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4
Q

Diagnosis of COPD

A

-Spirometry: FEV1/FVC < 0.70

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5
Q

Bronchodilators

A

-Inc FEV1 or change other spirometric variables
-Widening of the airways
-Improve emptying of the lungs

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6
Q

Beta agonists

A

-relax airway smooth muscles by stimulating beta 2 adrenergic receptors, which inc cyclic AMP and antagonizes bronchoconstriction - bronchodialation
-AE: tremor, hypokalemia, tachycardia, tacyphylaxis
-SABA: albuterol, levalbuterol
-LABA: Salmeterol, Formoterol, Olodaterol, Aformoterol, Indacaterol

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7
Q

Muscarinic antagonists

A

-block bronchoconstrictor effects of acetylcholine on the M3 muscarinic receptors expressed in the airway smooth muscle
-SAMAs have slightly longer duration than SABAs
-poor systemic absorption
-AE: dry mouth (anticholinergic), tiotropium may cause metallic taste, cough, nausea, blurred vision, glaucoma
-SAMA: Ipratropium bromide
-LAMA: Tiotropium (Spiriva), Aclidinium, Umeclidinium (incruse ellipta)

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8
Q

short acting bronchodilator combos

A

-prn for symptoms or scheduled
-SABA + SAMA
-improve efficacy and equal or lesser SE
-Albuterol/Ipratropium MDI
-Albuterol/Ipratropium neb

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9
Q

Long acting bronchodilator combos

A

-Stiolto
-Anoro Ellipta

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10
Q

ICS/LABA combo

A

-Fluticasone furoate/vilanterol (Breo)
-Fluticasone propionate/salmeterol (Advair, Wixela)
-Budesonide/fomoterol (Symbicort)
-mometasone/formoterol (Dulera)

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11
Q

Triple therapy inhaler

A

-Fluticasone furoate/umeclidinium/vilanterol (Trelegy Ellipta)
-Budesonide/glycopyrrolate/formoterol (Breztri aerosphere)

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12
Q

Oral steroids

A

-used for exacerbations not for chronic management

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13
Q

Roflumilast (Daliresp)

A

-PDE4 inhibitors reduce inflammation by inhibiting the breakdown of intracellular cAMP
-AE: nausea, diarrhea, weight loss, sleep disturbances, HA, worsen depression
-do not use with Theophylline

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14
Q

Assessment of COPD (ABCD assessment tool)

A

-need spirometric value of < 0.7 (FEV1/FVC)
-then grade severity based on gold guidelines, then assess symptoms/risk of exacerbations by using A,B,C,D grouping

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15
Q

GOLD 1 (mild)

A

> /= 80%

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16
Q

GOLD 2 (moderate)

A

50-79%

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17
Q

GOLD 3 (severe)

A

30-49%

18
Q

GOLD 4 (very severe)

A

< 30%

19
Q

Group A

A

-mMRC 0-1
-CAT < 10
-0 or 1 exacerbation, not leading to hospital admission

20
Q

Group B

A

-mMRC >/= 2
-CAT >/= 10
-0 or 1 exacerbation not leading to hospitalization

21
Q

Group C

A

-mMRC 0-1
-CAT < 10
- >/= 2 or >/= 1 leading to hospitalization

22
Q

Group D

A

-mMRC >/= 2
-CAT >/= 10
- >/= 2 or >/= 1 leading to hospitalization

23
Q

mMRC

A

-measure of breathlessness
-scale 0-4
-predicts future mortality risk

24
Q

CAT

A

comprehensive assessment of symptoms not just breathlessness

25
Q

ICS

A

don’t want to use in COPD patients unless they have features of asthma or inc eosinophil count

26
Q

Group A

A

-bronchodilator
-long acting (LAMA or LABA) are preferred unless patient has occasional dyspnea

27
Q

Group B

A

long acting bronchodilator (LAMA or LABA)

28
Q

Group C

A

LAMA

29
Q

Group D

A

-LAMA or
-LAMA + LABA or (if highly symptomatic CAT >20)
-ICS + LABA (if eos >/= 300)

30
Q

Adjusting therapy

A

-use follow up pharmacological treatment algorithm
-either dyspnea pathway or exacerbation pathway

31
Q

Dyspnea

A

-LABA or LAMA -> LABA + LAMA
-if eos is >300 or eos >100 and > 2 moderate exacerbations/ 1 hospitalization switch to LABA + ICS or triple therapy

32
Q

Exacerbations

A

-LABA or LAMA -> LABA + LAMA
-if eos is >300 or eos >100 and > 2 moderate exacerbations/ 1 hospitalization switch to LABA + ICS
-if eos > 100 switch to triple therapy
if eos < 100 switch to roflumilast or azithromycin (former smokers)

33
Q

long term oxygen therapy

A

in patients with severe resting chronic hypoxemia, long term oxygen therapy (>15 hours per day) improves survival

34
Q

Asthma-COPD Overlap

A

-Step 1: does the patient have chronic airway disease?
-Step 2: if the patient has over 3 features of either asthma or COPD then it is likely the right diagnosis
-Step 3: spirometry (< 0.7 ratio)
-Step 4: initial therapy (start treatment as for asthma with low or moderate ICS; usually add LABA &/or LAMA or continue if already prescribed

35
Q

Acute COPD exacerbation

A

-sx: increased dyspnea, increased sputum purulence and volume increased cough and wheeze
-goal O2: 88-92%
-causes: main: viral; 2nd: bacterial and pollution; last: fungal

36
Q

Acute exacerbation classification

A

-mild: Short acting bronchodilators only (ex. albuterol)
-moderate: Short acting bronchodilators + abx +/- steroids
-severe: hospitalization or ED visit +/- severe acute respiratory failure

37
Q

Acute exacerbation nonpharm

A

-O2 < 90% saturation (target 88-92)
-ventilation (NIV for severe respiratory acidosis (pH < 7.35 and PaCO2 > 45), severe dyspnea, persistent hypoxemia
-Intubation and mechanical ventilation: life threatening hypoxemia, etc.

38
Q

(Acute) bronchodilators

A

-albuterol or ipratropium

39
Q

(Acute) steroids

A

-Prednisone 40 mg po daily
-treat for 5 days
-use oral unless pt cannot tolerate
-no taper required unless over 14 days

40
Q

(Acute) abx

A

-treat for 5-7 days
-3 cardinal signs: increased dyspnea, increased sputum vol and purulence
-2 cardinal signs: one needs to be inc sputum purulence
-Augmentin 875 mg po or Unasyn 3 gm IV Q6h (renal dosing)
-Azithromycin 500 mg po daily x 3 days or 500 mg x 1 then 250 mg days 2-5
-doxycycline 100 mg po BID
-Risk for pseudomonas: Cefepime, Pop/tazo, levofloxacin, carbapenem

41
Q

(Acute) monitoring

A

-steroids: WBC, glucose
-abx: WBC w/ neutrophils, temp, cultures, SCr, CrCl, eGFR (if renal elimination)
-bronchodilators: HR, frequency of use

Asthma/Allergic Rhinitis/COPD (3 decks)

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