COPD Flashcards
What is COPD?
- Respiratory condition that causes airwau obstruction from lungs
What are some of the risk factors that could lead to COPD?
- TOBACCO SMOKE
- Smoke from fires or coal
- Marijuana
- Work pollutions
What is the difference between Emphysema and Bronchitis?
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- Emphysema: destruction of the alveloi in the lungs
- Bronchitis: Inflammation and narrowing of the bronchials
What are some of the symptoms that someone with COPD may have?
- SOB
- Cough
- Sputum Production
- Wheezing
Risk factors of smoking
What is one test that helps confirm COPD?
- Spirometry with FEV1/FVC < 0.70
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What four components must be followe to assess COPD?
- Degree of airflow
- Symptom assessment
- Risk of Exacerbation
- Presence of comorbidities
What is the the degree of airflow limitation in COPD assessment?
“GOLD”
- GOLD 1 - MILD - FEV1 > 80%
- GOLD 2 - MODERATE - FEV1 50 -79%
- GOLD 3 -SEVERE - FEV1 30 - 49%
- GOLD 4 - VERY SEVERE - FEV1 < 30%
What is the way that we assess symptoms for COPD?
- mMRC: assessing breathlessness (0-4 scale)
- CAT: assessing range of symptoms (0-40 scale)
What is a COPD exacerbation?
- increase in respiratory symptoms that worsens airflow
- Hospitalization = increased risk of death
What are some of the comorbities associated with COPD?
- CV disease
- Osteoporsis
- Diabetes
- Depression
- Anxiety
- Respiratory infections
- Lung cancer
With the combined assessment (Group A, B, E); what does each group mean?
- A: CAT < 10; mMRC 0 - 1; Exacerbations 0 - 1 (no hospital)
- B: CAT > 10; mMRC > 2; Exacerbations 0 - 1 (no hospital)
- E: 2 or more exacerbations with 1 leading to hospital
What are some non drug treatment options for COPD?
- Smoking cessation (slows progression of COPD)
- Vaccinations (flu & pneumonia)
- Inhaler technique and adherence
What are some of the drug treatments for COPD?
- Bronchodilators are 1st line (SAMA or SABA; LAMA or LABA)
- ICS ONLY when the eosinophil count > 300
- Combo (LAMA + LABA + ICS) when needed
- Roflumilast and Azithromycin in severe cases
What is the intital treatment for someone in group A?
- Bronchodilator (SAMA PRN, SABA PRN, LAMA or LABA)
What is the initial treatment for someone in group B?
- LAMA + LABA
What is the initial treatment for someone in Group E?
- LAMA + LABA
- LAMA + LABA + ICS (only when eos > 300)
What is the MOA for the muscarinic antagonist/anticholinergics?
- Causes bronchodilation by blocking acetylcholine at M3 receptors in smooth muscle
What are the SAMAs that are used for COPD?
- Ipratropim Bromide (Atrovent HFA - 2 puffs Q4-6H)
- Albuterol (Combivent Respimat - 1 puff Q4-6H)
What are the LAMAs that are used for COPD?
- Tiotropium (Spiriva Handihaler - Inhale 1 cap daily)
- Tiotropium (Spiriva Respimat - 2 puff daily)
- Glycopyrrolate + Formoterol/budesonide (Breztri)
- Umeclidinum + Vilanterol/fluticasone (Trelegy)
What are some side effects for the muscarinic antagonist/anticholinergics?
- Dry Mouth
- Upper Respiratory Tract Infections
- Cough
- Bitter Taste
What are some additional notes for the Muscarinic Antagonists/Anticholinergics?
- Handihaler: DO NOT swallow capsule
- ICS containing: rinse out mouth to avoid trush
what is the MOA for the Beta-2 agonist?
- bind to beta-2 receptors in the lung, causing relaxation of bronchial smooth muscle and bronchodilation
LABAs can be monotherapy for COPD, not asthma
What are some LABAs that are used for COPD?
- Salmeterol (Serevent Diskus) + Fluticasone (Adviar Diskus)
- Formoterol + Budesonide (Symbicort)
- Vilanterol + Fluticasone (Breo)
Formoterol + Budesonide + Glycopyrrolate (Breztri)
Vilanterol + Fluticasone + Umeclidinum (Trelegy)
What are some side effects for the LABAs used for COPD?
- Nervousness
- Tremor
- Tachycardia
- Palpitations
- Hyperglycemia
- Decreased Potassium
