COPD Flashcards
COPD
Chronic respiratory symptoms (dyspnea, cough, sputum production and/or exacerbations) due to abnormalities of the airways (bronchitis, bronchiolitis) and/or alveoli (emphysema) that cause persistent, often progressive, airflow obstruction
Consider diagnosis when:
-Persistent dyspnea
-Recurrent wheeze
-Chronic cough
-Resp tract infections
-Hx risk factors
Risk Factors
Exposures:
* Tobacco smoke exposure
* Indoor air pollution (burning wood & biofuel for cooking/heating)
* Occupational and environmental hazards (dusts and chemical fumes)
Host Factors:
* Genetic predisposition (alpha-1 antitrypsin deficiency)
* Airway hyperresponsiveness
* Impaired lung growth
Spirometry
Post Bronchodilator FEV1/FVC < 0.7
-assessment of severity of airflow obstruction
GOLD Grades
Gold 1: FEV >= 80%
Gold 2: 50% <= FEV1 < 80%
Gold 3: 30% <= FEV1 < 50%
Gold 4: FEV1 < 30%
Goals
-Relieve sx
-Improve exercise tolerance
-Improve health status
-Prevent disease progression
-Prevent exacerbations
-Reduce mortality
ABE Tool
Initial Pharmacological Treatment
Group A: LABA or LAMA
-Serevent or Striverdi or Spiriva
Group B: LABA AND LAMA combo
-Serevent or Striverdi AND Spiriva
Group E: LABA AND LAMA (consider LABA/LAMA/ICS if eos > 300)
-Serevent or Striverdi AND Spiriva (and Flovent or QVAR)
*Rescue SABA or SAMA should be prescribed to all patients for immediate symptom relief
-Albuterol
What if the patient has Asthma & COPD?
If a concurrent diagnosis of asthma is suspected, then follow asthma guidelines for pharmacotherapy
LABAs
Salmeterol, Olodaterol, Formoterol, Arformoterol
AE: tremor, tachycardia, hypokalemia
“OLS*
LAMAs
Greater effect on exacerbation reduction compared to LABAs (so preferred)
Caution in:
-narrow-angle glaucoma
-myasthenia gravis
-urinary retention
-BPH
BUGG
AE: dry mouth, cough, bitter taste, urinary retention D CUB
Tiotropium, Umeclidinium, Aclidinium
Spiriva, Ellipta, Pressair
“IUMS”
LABA/LAMA Combo
LABA/LAMA/ICS
Group E if blood eosinophils >300 can consider adding an ICS to LABA/LAMA
GOLD recommends to use single combo inhaler if possible
-Fluticasone + Umeclidinium = Trelegy
-Budesonide + Glyco, Formoterol = Breztri
ICS for COPD
- Controversial
- Increased risk for pneumonia
- Never as monotherapy
- Include ICS if patient has asthma + COPD
AGAINST USE IF: pneumonia events, EOS < 100, mycobacterial infections
Follow-up Pharmacological Treatment: 2 Paths
-If response to initial treatment is appropriate, then maintain current therapy
-If not: Consider predominant treatment trait to target (If both then follow exacerbations pathway)
- Dyspnea: LABA or LAMA to LABA and LAMA
- Exacerbations: LABA or LAMA then LABA/LAMA then LABA/LAMA/ICS then Rof/Azi
Roflumilast, Daliresp
250 or 500 mcg tabs
-250 for 4 weeks then 500 thereafter
patients with chronic bronchitis, severe to very severe COPD & a history of exacerbations
CI in severe liver disease
AE:
-nausea, diarrhea, loss of appetite
-HA, dizziness, occasional sleep problems
-back pain, flu sx, psychiatric (suicidality)
F that DB she got HANDSS
DDI: CYP450 3A4 and 1A2 (no use with inducers)
