COPD Flashcards

1
Q

Characteristics of COPD

A

Airflow limitation

  • Not fully reversible
  • Chronic & progressive

Preventable

Treatable

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2
Q

COPD Pathophysiology

A

Reversible: small airways dz, airway inflammation & increased airway resistance

Irreversible: parenchymal destruction, loss of alveolar attachment, decrease in elastic recoil, airway fibrosis

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3
Q

Risk Factors for COPD

A
  • Cigarette smoking 85-90%!
  • Exposures: env. Tobacco smoke, occupational dusts, chemicals and air pollution
  • Host factors: genetics predisposition (AAT deficiency), airway hyper-responsive, impaired lung growth
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4
Q

COPD vs Asthma: cells

A

COPD: neutrophils, large increase in macrophages

Asthma: eosiniophils, small increase in macrophages, activation of mast cells

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5
Q

COPD vs Asthma​: mediators

A

COPD: LTB4, IL8, TNF-a

Asthma: LTD4, IL4, IL5

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6
Q

COPD vs Asthma: Consequences

A

COPD: parenchymal destruction, mucus metaplasia, glandular enlargement

Asthma: thickening of basement membrane; mucus metaplasia, glandular enlargement

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7
Q

COPD vs Asthma: response to Tx

A

COPD: Glucocorticoids have variable effect

Asthma: Glucocorticoids inhibit inflammation

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8
Q

COPD: symptoms

A

Chronic cough
Sputum production

Dyspnea

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9
Q

COPD: PE

A
  • Cyanosis of mucosal membranes
  • Barrel chest
  • ↑resting respiratory rate
  • Shallow breathing
  • Pursed lips during expiration
  • Use of accessory respiratory muscles
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10
Q

COPD: Diagnostic Tests

A
  • Spirometry with reversibility testing
  • Radiograph of chest
  • Arterial blood gas (not routine)
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11
Q

COPD Prevention

A
  • Smoking cessation
  • Vaccination
    • Influenza
      • ↓ illness causing hospitalizations in COPD
      • ↓ mortality in COPD
  • Pneumococcal
    • ↓ incidence of community acquired pneumonia in COPD
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12
Q

COPD: medication classes

A
  • SABA
  • SAA – short acting antichol
  • LABA
  • LA-anticholinergics
  • ICS
  • Phosphodiesterase Inhibitors
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13
Q

COPD: SABAs

A
  • Albuterol
  • Levalbuterol
  • Pirbuterol
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14
Q

COPD: SAAs

A

Ipratropium

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15
Q

COPD: LABAs

A
  • Salmeterol
  • Formeterol
  • Arformeterol
  • Indacaterol
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16
Q

COPD: LA-anticholinergics

A

Tiotropium

Aclidinium

17
Q

COPD: ICS

A
  • Beclomethasone
  • Fluticasone
  • Mometasone
  • Budesonide
  • Ciclesonide
18
Q

COPD: Phosphodiesterase Inhibitors

A

Roflumilast (Daliresp)

19
Q

Roflumilast (Daliresp): MOA

A

Selective phosphodiesterase-4 (PDE-4) inhibitor

20
Q

Roflumilast (Daliresp)​: Dosing

A

500 mcg orally once daily [$300/month]

(Phosphodiesterase Inhibitors)

21
Q

Roflumilast (Daliresp): Adjunctive therapy

A

for severe COPD (refractory cases)

  • Pre and Post bronchodilator FEV1 greater in roflumilast group vs. placebo
  • Reduces exacerbations in patients with FEV1 < 50, chronic bronchitis,
  • history of frequent exacerbations

(Phosphodiesterase Inhibitors)

22
Q

Roflumilast (Daliresp): Adverse Effects

A

Gastrointestinal:

  • 9.5% suffered from diarrhea vs. 2.7% in the placebo group.
  • 4.7% had nausea compared 1.4% who received placebo.

Psychiatric

  • Insomnia, anxiety, and depression
  • Suicidal ideation
  • Contraindicated in patients with moderate to severe hepatic impairment (CP Class B or C)

(Phosphodiesterase Inhibitors)