COPD Flashcards
Where can updated COPD guidelines be found?
Global Initiative for Chronic Obstructive Lung Disease (GOLD)
Define: Chronic Obstructive Pulmonary Disease (COPD)
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
What are clinical indicators when considering diagnosis of COPD?
-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)
Define: GOLD 1
mild, FEV1 80%+
Define: GOLD 2
moderate, FEV1 50%-80%
Define: GOLD 3
severe, FEV1 30%-50%
Define: GOLD 4
very severe, FEV1 < 30%
Define: Group E
2+ moderate exacerbations or 1+ leading to hospitalizations (questionnaire score doesn’t matter)
Define: Group A
0-1 exacerbations (no hospitalizations) AND mMRC 0-1 or CAT <10
Define: Group B
0 or 1 exacerbations (no hospitalizations) AND mMRC 2+ or CAT 10+
What is the initial pharmacological treatment of Group E patients?
LABA + LAMA (+ ICS if blood eos is 300+)
What is the initial pharmacological treatment for Group A patients?
bronchodilator (short or long-acting, but long preferred)
What is the initial pharmacological treatment for Group B patients?
LABA or LAMA
What are the goals of treatment for COPD?
reduce symptoms and reduce risk (prevent disease progression, prevent and treat exacerbations, reduce mortality)
What type of COPD patient would need a rescue short-acting bronchodilator?
all COPD patients should have one for immediate symptom relief regardless if group A, B, E
When should a beta2-agonist v antimuscarinics be used as short-acting bronchodilator?
beta2-agonists can be used to inflate alveoli for air exchange (emphysema) and antimuscarinics can be used if there is sputum production
What factors would indicate ICS incorporation to COPD therapy?
-history of hospitalizations for exacerbations
-2+ moderate exacerbations of COPD/year
-blood eosinophils 300+ cells/mcL
-history of concomitant asthma
What factors would suggest that a patient should NOT be given ICS?
-repeated pneumonia events
-blood eosinophils < 100 cells/mcL
-history of mycobacterial infection
When would roflumilast be indicated?
if patient has failed LABA + LAMA + ICS and FEV1 < 50% and chronic bronchitis
What are the contraindications of roflumilast?
moderate-severe hepatic impairment and avoid in patients with history of depression or suicidal thought
Side Effects: Roflumilast
weight loss, decreased appetite, diarrhea, nausea, backache, dizziness, headache, insomnia
What vaccines are recommended in COPD patients?
influenza (yearly), pneumococcal (one dose PCV20 or PCV15 followed by PPSV23), Tdap, COVID-19, zoster/shingles (pt >50), RSV (pt >60)
What COPD patients would require pulmonary rehabilitation as nonpharm treatment?
Group B and E
Define: COPD Exacerbation
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
How would a mild exacerbation be treated?
short-acting bronchodilator
How would a moderate exacerbation be treated?
short-acting bronchodilator + oral corticosteroids (possibly antibiotics)
How would a severe exacerbation be defined?
requires hospitalization or ED and may be associated with acute respiratory failure
How would systemic steroids be dosed for a patient experiencing an exacerbation?
prednisone 40mg po daily for 5 days (not to exceed 5 days!)
How could systemic corticosteroids be useful for treatment of exacerbations?
improve lung function (FEV1), improve oxygenation, shorten recovery time and hospital duration
What are the 3 cardinal symptoms that would indicate antibiotic use in an exacerbation?
-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
What is goal oxygen level?
SaO2= 88-92%
How many hours should a patient be on oxygen a day to increase the chance of survival?
15 hours
