COPD

Question 1

Where can updated COPD guidelines be found?

Answer 1

Global Initiative for Chronic Obstructive Lung Disease (GOLD)

Question 2

Define: Chronic Obstructive Pulmonary Disease (COPD)

Answer 2

a heterogeneous lung condition characterized by chronic respiratory symptoms (dyspnea, cough, sputum production) due to abnormalities of the airway (bronchitis) and/or alveoli (emphysema) that causes persistent, often progressive, airflow obstruction

Question 3

What are clinical indicators when considering diagnosis of COPD?

Answer 3

-dyspnea (progressive over time, worse with exercise, persistent)
-recurrent wheeze
-chronic cough
-recurrent lower respiratory tract infections
-risk factors (tobacco smoke, occupational dust/fumes/vapors, genetic factors)

Question 4

Define: GOLD 1

Answer 4

mild, FEV1 80%+

Question 5

Define: GOLD 2

Answer 5

moderate, FEV1 50%-80%

Question 6

Define: GOLD 3

Answer 6

severe, FEV1 30%-50%

Question 7

Define: GOLD 4

Answer 7

very severe, FEV1 < 30%

Question 8

Define: Group E

Answer 8

2+ moderate exacerbations or 1+ leading to hospitalizations (questionnaire score doesn’t matter)

Question 9

Define: Group A

Answer 9

0-1 exacerbations (no hospitalizations) AND mMRC 0-1 or CAT <10

Question 10

Define: Group B

Answer 10

0 or 1 exacerbations (no hospitalizations) AND mMRC 2+ or CAT 10+

Question 11

What is the initial pharmacological treatment of Group E patients?

Answer 11

LABA + LAMA (+ ICS if blood eos is 300+)

Question 12

What is the initial pharmacological treatment for Group A patients?

Answer 12

bronchodilator (short or long-acting, but long preferred)

Question 13

What is the initial pharmacological treatment for Group B patients?

Answer 13

LABA or LAMA

Question 14

What are the goals of treatment for COPD?

Answer 14

reduce symptoms and reduce risk (prevent disease progression, prevent and treat exacerbations, reduce mortality)

Question 15

What type of COPD patient would need a rescue short-acting bronchodilator?

Answer 15

all COPD patients should have one for immediate symptom relief regardless if group A, B, E

Question 16

When should a beta2-agonist v antimuscarinics be used as short-acting bronchodilator?

Answer 16

beta2-agonists can be used to inflate alveoli for air exchange (emphysema) and antimuscarinics can be used if there is sputum production

Question 17

What factors would indicate ICS incorporation to COPD therapy?

Answer 17

-history of hospitalizations for exacerbations
-2+ moderate exacerbations of COPD/year
-blood eosinophils 300+ cells/mcL
-history of concomitant asthma

Question 18

What factors would suggest that a patient should NOT be given ICS?

Answer 18

-repeated pneumonia events
-blood eosinophils < 100 cells/mcL
-history of mycobacterial infection

Question 19

When would roflumilast be indicated?

Answer 19

if patient has failed LABA + LAMA + ICS and FEV1 < 50% and chronic bronchitis

Question 20

What are the contraindications of roflumilast?

Answer 20

moderate-severe hepatic impairment and avoid in patients with history of depression or suicidal thought

Question 21

Side Effects: Roflumilast

Answer 21

weight loss, decreased appetite, diarrhea, nausea, backache, dizziness, headache, insomnia

Question 22

What vaccines are recommended in COPD patients?

Answer 22

influenza (yearly), pneumococcal (one dose PCV20 or PCV15 followed by PPSV23), Tdap, COVID-19, zoster/shingles (pt >50), RSV (pt >60)

Question 23

What COPD patients would require pulmonary rehabilitation as nonpharm treatment?

Answer 23

Group B and E

Question 24

Define: COPD Exacerbation

Answer 24

an event characterized by dyspnea and/or cough and sputum that worsen over < 14 days that is associated with increased inflammation caused by: airway infection, pollution, or other insults to the lungs

Question 25

How would a mild exacerbation be treated?

Answer 25

short-acting bronchodilator

Question 26

How would a moderate exacerbation be treated?

Answer 26

short-acting bronchodilator + oral corticosteroids (possibly antibiotics)

Question 27

How would a severe exacerbation be defined?

Answer 27

requires hospitalization or ED and may be associated with acute respiratory failure

Question 28

How would systemic steroids be dosed for a patient experiencing an exacerbation?

Answer 28

prednisone 40mg po daily for 5 days (not to exceed 5 days!)

Question 29

How could systemic corticosteroids be useful for treatment of exacerbations?

Answer 29

improve lung function (FEV1), improve oxygenation, shorten recovery time and hospital duration

Question 30

What are the 3 cardinal symptoms that would indicate antibiotic use in an exacerbation?

Answer 30

-increased dyspnea
-increased sputum volume
-increased sputum purulence
may consider antibiotics even if all 3 signs aren’t present but pt is on mechanical ventilation

Question 31

What is goal oxygen level?

Answer 31

SaO2= 88-92%

Question 32

How many hours should a patient be on oxygen a day to increase the chance of survival?

Answer 32

15 hours