COPD

Question 1

What is COPD?

Answer 1

This is a respiratory disease which causes obstructed airflow FROM the lungs.
-It is Progressive
-Symptoms: Dyspnea, cough, sputum production
-One of the leading causes of death worldwide
-Results in Bronchitis and Emphysema
-Causes: tobacco smoke, air pollutants

Question 2

Asthma vs. COPD

Answer 2

COPD
-Usually > 40 y.o
-Sputum? Yes
-Allergies uncommon
-Symptoms: Persistent
-Disease Progression: YES, worsens with time
-First-line treatment: Bronchodilators

ASTHMA
-Ususally < 40 y.o
-Sputum? Infrequent
-Allergies common
-Symptoms: Intermittent
-Disease Progression: No, its stable
-First-line treatment: ICS

Question 3

Diagnosis of COPD

Answer 3

Spirometry:

FEV1/FVC < 0.7

Question 4

GOLD Grading

Answer 4

GOLD guidelines use a grading system of 1-4 to classify patients based on spirometry results.
1-Mild
4-Very Severe

Question 5

Assessment of Symptoms

Answer 5

MMRC - dyspnea scale which assess breathlessness

CAT - comprehensive assessment of symtoms

Question 6

Combined Assessment of COPD

Answer 6

0-1 Moderate Exacerbations (not leading to hospitalization)
-GroupA
CAT < 10
*Treat with Bronchodilator (PRN SAMA, SABA, LAMA or LABA)

-GroupB
CAT >= 10
*Treat with LAMA+LABA

> =2 Moderate Exacerbations (leading to hospitalization)
-GroupE
*Treat with LAMA+LABA
-If blood eosinophils >= 300, consider adding an ICS

Question 7

Treatment Escalation (Primary Problem: Dyspnea)

Answer 7

If the patient has been previously using LAMA or LABA:

1) LAMA+LABA

Question 8

Treatment Escalation (Primary Problem: Exacerbations)

Answer 8

IF patient has been using LAMA or LABA:

Eosinophil < 300?
-LAMA+LABA

Eosinophil >= 300?
-LAMA+LABA+ICS

-Azithromycin or Roflumilast can be added on for persistent symptoms

Question 9

Bronchodilators

Answer 9

1) Muscarinic Antagonists - Blocks Ach at M3 receptors

2) Beta-2 Agonists - Activate Beta-2 receptors

Question 10

Muscarinic Antagonists (SAMA & LAMA)

Answer 10

1) Single Drug
-Ipratropiumn bromide (Atrovent) <—this is the only SAMA, the others are LAMA
-Tiotropium (Spiriva)
-Aclidinium (Tudorza)
-Glycopyrrolate
-Umeclidinum (Incruse Ellipta)

2) Dual Therapy
-Ipratropium+Albuterol (Combivent)
-Tiotropium+Olodaterol (Stiolto)
-Aclidinum+Formoterol (Duaklir Pressair)
-Glycopyrrolate+Formoterol (Bevespi)
-Umeclidinum+Vilanterol (Anoro Ellipta)

3) Triple Therapy
-Glycopyrrolate+Formoterol+Budesonide (Breztri)
-Umeclidinum+Vilanterol+Fluticasone (Trelegy Ellipta)

Question 11

Beta Agonists for COPD (SABA & LABA)

Answer 11

All of the following are LABAs

Single Drug
-Salmeterol (Serevent)
-Formoterol
-Olodaterol
-Vilanterol

Dual and Triple Therapy products are covered in the previous card.

Question 12

Roflumilast

Answer 12

MOA: PDE4 inhibitor resulting in smooth muscle relaxation
Contraindication: Mod-Sev Liver damage
Notable SE: Weight loss and diarrhea