COPD Flashcards
What are the symptoms of COPD?
- dyspnea
- cough
- sputum production
- wheezing
- chronic, progressive symptoms not fully reversible
- exacerbations are common
What genetic condition can predispose someone to COPD?
alpha-1 antitrypsin deficiency
What is required to assess lung function?
spirometry- amount of air a person can breathe out
What confirms a diagnosis of COPD?
post-bronchodialator FEV1/FVC <0.7
What are the key differences of COPD?
- common sputum production
- persistent symptoms
- progressive disease
- treatment with bronchodilators
What post-bronchodilator FEV1 is mild (GOLD 1)?
FEV1 ≥80%
What post-bronchodilator FEV1 is moderate (GOLD 2)?
FEV1 50-79%
What post-bronchodilator FEV1 is severe (GOLD 3)?
FEV1 30-49%
What post-bronchodilator FEV1 is very severe (GOLD 4)?
FEV1 <30%
How are COPD symptoms assessed?
- CAT (0-40)
- mMRC (0-4)
higher numbers are worse symptoms
What is a COPD exacerbation?
increase in respiratory symptoms that increase over <14 days
What is a combined assessment of COPD?
symptoms assessment (CAT and mMRC) and risk of exacerbations (A,B,E)
What is nonpharm treatment for COPD?
- smoking cessation
- pneumonia and flu vaccines
- inhaler technique
- long term oxygen treatment
What is first-line treatment for COPD?
Bronchodilators:
1. SAMA (short-acting muscarinic antagonist)
2. SABA (short-acting beta 2 agonist)
3. LAMA
4. LABA
When are ICS used in COPD?
- eosinophil count ≥300
- eosinophil count ≥ 100 and not controlled on LAMA+LABA
What is a group A COPD patient?
- CAT <10
- mMRC 0-1
- 0-1 moderate exacerbations (oral steroid± antibiotics) not requiring hospitalization
What is a group B COPD patient?
- CAT ≥10
- mMRC ≥2
- 0-1 moderate exacerbations (oral steroid± antibiotics) not requiring hospitalization
What is a group E COPD patient?
- ≥ 2 moderate exacerbations
- ≥1 exacerbation leading to hospitalization
What treatment should all patients have in addition to long-acting maintenance medications?
SABA and/or SAMA to relieve acute symptoms as needed
What are the preferred treatment for group A patients?
SAMA/SABA prn + LAMA/LABA
What are the preferred treatment for group B patients?
LAMA+LABA
What are the preferred treatment for group E patients?
LAMA+LABA
if eosinophils ≥300 consider LAMA+LABA+ICS
What agent is a SAMA?
Ipratropium (Atrovent HFA)
How is Ipratropium (Atrovent HFA) dosed?
MDI: 2 inhalations Q 4-6 hours prn
What agent is a SAMA+SABA?
ipratropium+albuterol (Combivent Respimat)
How is ipratropium+albuterol (Combivent Respimat) dosed?
MDI: 1 inhalation Q 4-6 hours prn
What are warnings with muscarinic antagonists/ anticholinergics (SAMA/LAMA)?
Use caution in patients with narrow-angle glaucoma, urinary retention, BPH, or bladder neck obstruction
What are SEs with muscarinic antagonists/ anticholinergics (SAMA/LAMA)?
- DRY MOUTH
- upper respiratory tract infection (sinusitis, nasopharyngitis)
- cough
- bitter taste
What should be monitored for patients with COPD?
- smoking status
- COPD questionarres
- annual spiromerty
What agents are LAMAs?
- Tiotropium (Spiriva HandiHaler, Spiriva Respimat)-DPI
- Aclidinium-DPI
- Glycopyrrolate (only in combination)-MDI
- Umeclidinium- DPI
- Revefenacin-nebulizer
What is dosing for Spiriva Handihaler?
Tiotropium DPI: inhale contents of 1 capsule via HandiHaler device; do not swallow capsules whole
What is dosing for Spiriva Respimat?
Tiotropium MDI: 2 inhalation daily
What agents are LABAs?
- Salmeterol- DPI
- Formoterol-MDI
- Arformoterol- nebulizer
- Vilaterol (combination only)-DPI
- Olodaterol-MDI
How do PDE-4 inhibitors work to treat COPD?
increase cAMP levels to reduce lung inflammation; used in combination with a long-acting bronchodilator for very severe COPD
What are boxed warnings with beta 2 agonists?
increase risk of asthma-related deaths when used alone, should only be used in asthma patients not adequately controlled on ICS
What are SEs with beta-2 agonists?
- nervousness
- tremor
- tachycardia
- palpitations
- hyperglycemia
- hypokalemia
- cough
What are warnings with PDE-4 inhibitor, Roflumilast?
- WEIGHT LOSS
- psychiatric events (depression, mood changes), suicidality
What are SEs with PDE-4 inhibitor, Roflumilast?
- DIARRHEA
- nausea/decreased appetitie
- insomnia
- headache
What needs to be monitored with Roflumilast?
LFTs
What drugs interact with Roflumilast?
strong CYP3A4 enzyme inducers:
carbamazepine, phenobarbital, phenytoin, rifampin
CYP3A4 and 1A2 inhibitors with increased concentration of Roflumilast:
erythromycin, ketoconazole, fluvoxamine, cimetedine
What are the contraindications to LABAs?
- status asthmaticus
- monotherapy in asthma
What are the contraindications to using Roflumilast?
moderate to severe liver impairment
Ipratropium bromide MDI
Atrovent HFA
Tiotropium MDI
Spiriva Respimat
Ipratropium bromide + albuterol MDI
Combivent Respimat
Tiotropium capsule DPI
Spiriva HandiHaler
Umeclidinium+ vilanterol+ fluticasone DPI
Trellagy Ellipta
Salmeterol DPI
Sverent Diskus
Salmeterol + fluticasone
Advair Disks, Wixela Inhub
Fomoterol+ budesonide MDI
Symbicort, Breyna
Formoterol + budesonide + glycopyrrolate MDI
Breztri Aerosphere
Vilanterol + fluticasone DPI
Breo Ellipta
Roflumilast
Daliresp
How is the Atrovent HFA primed?
spray 2 times away from face, prime again if > 3days from last use
How is Atrovent HFA used?
- make sure canister is fully inserted into the actuator
- remove protective dust cap and check for foreign objects
- you do not have to shake before using
- breath fully out of your mouth and then put lips around inhaler keep inhaler upright
- keep you eyes closed so no medications will be sprayed into the eyes
- breath slowly and deeply and hold breath for 10 seconds
- wait 15 seconds then repeat
- rinse mouth piece under water weekly
How are Respimat products used?
TOP:
1. turn the clear base
2. open the cap and breathe out slowly and fully
3. press the dose release button slowly, deep inhale; do not cover vents
4. wipe mouth piece with wet tissue/cloth weekly
How are Respimat products primed?
- turn clear base in the direction of the arrow on the label until it clicks and flip cap until it snaps fully open
- point the inhaler toward the group away from your face and press the dose release button
- repeat steps until spray is visible
- > 3 days release 1 spray towards the ground
- > 21 days repeats priming instructions
How is Spiriva HandiHaler used?
- open the device by pressing the green button and lifting the cap upwards
- open the mouthpiece, center chamber should be showing
- remove Spiriva capsule from blister package and place into the chamber
- firmly close mouth piece until you hear a click
- push green button flat once, do not shake
- turn head away from the inhaler and breath out
- raise HandiHaler to mouth in a horizontal position
- inhale deeply and fully until you feel the capsule rattle
- you must inhale twice to get the full dose
- tip out the used capsule into a trash can without touching it
- clean monthly and let airdry for 24 hours
How is Pressair devices used?
- remove protective cap
- press button the button will turn green when ready for inhalation
- breath quickly and deeply until you hear a click (DO NOT hold down green button while breathing in)
- control window will turn to red which indicated the full dose has been received
