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Clinical Therapeutics > COPD > Flashcards

COPD Flashcards

1
Q

COPD definition

A

Common, preventable and treatable disease that is characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases

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2
Q

What are the 3 most common indicators for COPD

A

Dyspnea, chronic cough, chronic sputum production

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3
Q

What are some associated considerations with dyspnea?

A

Persistent, progressive, worse with exercise/activity

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4
Q

What are some associated considerations with chronic cough?

A

May be intermittent and unproductive

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5
Q

What are some associated considerations with chronic sputum production?

A

Any chronic pattern of production may indicate COPD

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6
Q

COPD symptoms pattern

A

Chronic, usually continuous;worse with exercise

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7
Q

Asthma symptom pattern

A

Vary day-to-day, associated with triggers

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8
Q

What is the history for COPD?

A

Exposure to noxious particles and gases

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9
Q

What is the history for asthma?

A

Allergies and history of asthma+/- family history of asthma

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10
Q

What causes airway inflammation in COPD?

A

Neutrophils and/or eosinophils

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11
Q

What causes airway inflammation in asthma?

A

Eosinophils and/or neutrophils

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12
Q

What are some COPD phenotypes?

A

Chronic bronchitis, emphysema, asthma-COPD overlap, alpha-1 antitrypsin deficiency

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13
Q

Chronic bronchitis

A

Chronic productive cough for 3 mos in each of 2 successive years when other causes of chronic cough have been excluded

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14
Q

Emphysema

A

Abnormal permanent enlargement of airspace’s distal to the terminal bronchioles

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15
Q

What is consistent with a diagnosis of COPD?

A

Any chronic pattern of sputum production may indicate COPD

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16
Q

What is the gold standard for COPD diagnosis?

A

Lung function assessment: Spirometry

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17
Q

What 2 main areas are tested with spirometry?

A

The amount of air exhaled

The speed in which air is exhaled

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18
Q

The amount of air exhaled

A

Volume

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19
Q

The speed in which air is exhaled

A

Flow

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20
Q

FEV1

A

Forced expiratory volume in1 second: volume of air expired in the 1st second of the maneuver

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21
Q

Volume of air spired in the 1st second of the maneuver

A

FEV1

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22
Q

FVC

A

Forced vital capacity: the total volume of air forcibly exhaled in one breathe

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23
Q

The total volume of air forcibly exhaled in one breath

A

FVC

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24
Q

FEV1/FVC ratio

A

The fraction of air exhaled in the 1st second relative to the total volume exhaled

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25
Q

An obstructive disorder is when the FEV1/FVC ratio is what?

A

< or equal to 70%

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26
Q

Mild severity is if the FEV1 is what?

A

> 80% predicted

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27
Q

Moderate severity is if the FEV1 is

A

> 50-80% predicted

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28
Q

Severe is if the FEV1 is what

A

> 30-50% predicted

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29
Q

Very severe is if the FEV1 is what

A

<30% predicted

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30
Q

What is the role of spirometry in follow up care?

A

Identifies rapidly declining lung function, non-pharmacological interventions, can be used to help rule out alternative diagnoses

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31
Q

According to the GOLD guidelines, what PFT result would be consistent with a COPD diagnosis?

A

FEV1/FVC <70%

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32
Q

What are the goals of COPD therapy?

A

Relieve symptoms, improve exercise tolerance, improve health status, prevent progression, prevent and treat exacerbation, reduce mortality

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33
Q

Mild management of COPD

A

Short acting bronchodilators only

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34
Q

Moderate management for COPD

A

Short acting bronchodilators PLUS Abx and/or oral corticosteroids

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35
Q

Management for severe COPD

A

Requires hospitalization or visits the ED may also be associated with respiratory failure

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36
Q

What is the treatment for a COPD exacerbation?

A

O2 and obtain an ABG, Short acting agents as a bronchodilator (or combo of beta 2 agonist and anticholinergic), oral or IV steroids, Abxs

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37
Q

Why is oxygen needed during an acute exacerbation?

A

Hypoxia, want to obtain ABG after 30-60 mins to ensure no acidosis

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38
Q

What type of bronchodilator treatment may be preferable during and exacerbation?

A

Short acting agents

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39
Q

Why are oral or IV steroids added for exacerbations?

A

Shorten recovery time, improve lung function (FEV1) and hypoxemia, reduce relapse and treatment failure

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40
Q

What is the mMRC or the CAT?

A

Evaluate the symptom burden, COPD assessment tests

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41
Q

What would a high symptoms burden score be for the mMRC?

A

Greater than a 2

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42
Q

What would a high symptom burden be for the CAT?

A

Greater than 10

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43
Q

What is Group A for COPD risk groups?

A

Less symptoms, low exacerbation risk

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44
Q

What is group B?

A

More symptoms, low exacerbation risk

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45
Q

What is group C?

A

Less symptoms, high exacerbation risk

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46
Q

What is group D?

A

More symptoms, high exacerbation risk

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47
Q

Which two groups have greater than 1 hospitalization?

A

C and D

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48
Q

Which two groups have a high mMRC and CAT>?

A

B and D

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49
Q

Which two groups have a high exacerbation risk?

A

C and D

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50
Q

Which two groups have less symptoms?

A

A and C

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51
Q

Which two groups have more symptoms?

A

B and D

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52
Q

What are the SABAs?

A

Albuterol (Proair, Proventil, Ventolin)

Levalbuterol (Xopenex)

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53
Q

What is a SAMA?

A

Ipratropium (Atrovent)

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54
Q

What are the examples of the LABAs?

A 
Salmeterol (Serevent)
Formoterol (Perforomist)
Arformoterol (Brovana)
Indacaterol (Arcapta)
Olodaterol (Striverdi)
Vilanterol (in combos only)
55
Q

What are the LAMAs?

A

Aclidinium (Tudorza)
Glycopyrrolate (Seebri)
Tiotropium (Spiriva)
Umeclidinium (Incruse)

56
Q

Regular use of what improves FEV1 and symptoms?

A

SABA or SAMA

57
Q

What route is preferred for bronchodilators?

A

Inhaled

58
Q

What significantly improve FEV1, dyspnea, health status and decrease exacerbation rates?

A

LABAs and LAMAs

59
Q

Combination therapy is superior to what?

A

To either class alone at improving FEV1 and symptoms

60
Q

LAMAs have a greater effect on exacerbation reduction compared with?

A

LABAs

61
Q

SABA +/- SAMA are recommended for what?

A

Initial bronchodilators to treat an acute exacerbation

62
Q

PRN use of short acting bronchodilators can offer additional what?

A

Benefit when added to long acting bronchodilator regimens

63
Q

SAMAs may be preferred over SABAs when used as what?

A

Monotherapy in prevention acute mild-moderate exacerbations in pts with mod-severe COPD

64
Q

Atrovent HFA

A

Ipratropium Bromide; SAMA short acting antimuscarinic

65
Q

What is the indication for Atrovent HFA (Ipratropium Bromide)?

A

Maintenance treatment of bronchospasm associated with COPD

66
Q

Combivent

A

Ipratropium + Albuterol

Short acting bronchodilator combo

67
Q

Indication for Combivent

A

COPD uncontrolled on a regular aerosol bronchodilator and require a second

68
Q

DuoNeb

A

Albuterol + Ipratropium

69
Q

Which is preferred for beta-2 agonists and antimuscarinics?

A

Long-acting formulations

70
Q

Serevent

A

Salmeterol

Long acting Beta agonist (LABA)

71
Q

Foradil

A

Formoterol;

LABA

72
Q

Arcapta

A

Indacaterol; LABA

73
Q

Striverdi

A

Olodaterol; LABA

74
Q

Brovana

A

Arformoterol; LABA for nebulizer

75
Q

Brovana (Aformoterol) features

A

Store in fridge, dont combine with other nebulizer solutions

76
Q

Perforomist

A

Formoterol Fumarate; LABA for nebulizer

77
Q

Perforomist (Formoterol Fumarate) features

A

Store in fridge, dont combine with other nebulizer solutions

78
Q

Tudorza

A

Aclidinium; long acting antimuscarinic LAMA

79
Q

Spiriva

A

Tiotropium; LAMA

80
Q

Incruse

A

Umeclidinium; LAMA

81
Q

Seebri

A

Glycopyrrolate; LAMA

82
Q

What is the correct treatment for group A in COPD risk groups?

A

Short or long acting bronchodilator

83
Q

How can we evaluate the effect of the short or long acting bronchodilator in group A?

A

Continue, stop, or try alternative bronchodilators

84
Q

What is the treatment for group B?

A

LAMA or LABA

85
Q

What needs to be done if someone in group B on either a LAMA or LABA has persistent symptoms?

A

Put them on a LAMA AND a LABA

86
Q

What is the correct treatment for someone in group C?

A

LAMA

87
Q

If group C has further exacerbations,

A

LAMA + LABA is preferred; could do a LABA + ICS

88
Q

What is the treatment for someone in group D?

A

LAMA + LABA

89
Q

If someone in group D has further exacerbations,

A

LAMA + LABA + ICS

90
Q

If someone in group D who’s on LAMA + LABA + ICS still has exacerbations,

A

Consider Roflumilast if FEV1 <50%; Consider macrolide (former smokers)

91
Q

Anoro/Ellipta

A

Umeclidinium/Vilanterol; LAMA + LABA

92
Q

Stiolto/Respimat

A

Tiotropium/Olodaterol; LAMA + LABA

93
Q

Utibron/Neohaler

A

Glycopyrrolate/Indacaterol; LAMA + LABA

94
Q

Bevespi/Aerosphere

A

Glycopyrrolate/Formoteraol LAMA + LABA

95
Q

RegularIm treatment with ICS increases the risk of what?

A

Pneumonia, especially for those with severe disease

96
Q

Triple ICS/LAMA/LABA does what?

A

Improves lung fxn, symptoms, and health status and reduces exacerbations compared to ICS/LABA or LAMA monotherapy

97
Q

What is a once daily ICS/LABA combo therapy?

A

Breo Ellipta

98
Q

Fluticasone Furoate/vilanterol

A

Breo Ellipta

99
Q

Features of Breo Ellipta

A

No cleaning, priming, no shaking

100
Q

All respimat devices expire in how long?

A

90 days

101
Q

All Ellipta devices expire when?

A

6 weeks

102
Q

What is a once daily ICS/LABA/LAMA triple therapy?

A

Trelegy Ellipta

103
Q

Fluticasone Furoate/ vilanterol/ umeclidinium

A

Trelegy Ellipta

104
Q

Trelegy Ellipta

A

Long-term once daily maintenance treatment of pts with COPD

105
Q

What group can the ICS/LABA/LAMA Therapy be given in?

A

Group D

106
Q

What is a selective PDE-4 inhibitor used for COPD?

A

Roflumilast (Daliresp)

107
Q

Who can be on Roflumilast?

A

Once daily add on in pts not controlled on bronchodilator, group D

108
Q

Pros to Roflumilast

A

Oral capsule, weight loss, may decrease exacerbation frequency

109
Q

What are the cons to Roflumilast?

A

Psyc disturbances? Metabolized mostly via CYP3a4 and CYP1A2

Measure most common adverse effect

110
Q

Consider ABX therapy if patient exhibits:

A

Signs of lower resp tract infection, severe exacerbation requiring mechanical ventilation

111
Q

What are the 3 cardinal symptoms of an infection in COPD?

A

Increased dyspnea, increased sputum production, increased sputum purulence

112
Q

What are some non-bronchodilator options?

A

Mucolytics, Antitussives, Leukotriene Modifiers, Anti-TNF alpha antibody, VitD

113
Q

What Mucolytics can be used?

A

N-acetylcysteine, Carbocysteine

114
Q

How can mucolytics help?

A

May reduce exacerbations and improve health status in certain populations

115
Q

What is part of pulmonary rehab?

A

Exercise training, education, psychological counseling, nutritional counseling

116
Q

Which groups of COPD can benefit from pulm rehab?

A

B C and D

117
Q

What are some dual combination products?

A

Aclidinium Bromide + Formoteral Fumarate DPI

118
Q

What are some triple therapy combos?

A

Budesonide + Glycopyrronium + Formoterol

Beclometasone + Glycopyrrolate + Formoterol

119
Q

What treatment option has been proven to slow the progression of COPD?

A

Smoking cessation

120
Q

Which vaccine should a vaccine-naive person aged >65 years get?

A

PCV13 at age > 65 years

121
Q

Person who previously received PPSV23 at age >65 years

A

PPSV23 already received, get PCV13 > 1 year

122
Q

Person who previously received PPSV23 before 65 who are now >65

A

PPSV23 already received at age <65, PCV13 at age > 65, PPSV23 1 year later

123
Q

DPIs must be inhaled more forcefully and rapidly than an MDI?

A

True

124
Q

All MDIs should be cleaned weekly

A

True

125
Q

DPIs should be cleaned with water

A

False

126
Q

DPIs can be used with a spacer

A

False

127
Q

Positioning is important when loading doses for na MDI or DPI

A

True

128
Q

All MDIs should be shaken prior to use

A

False

129
Q

MDIs can be placed in a bowl of water to determine the number of remaining doses?

A

False

130
Q

What are some common red flags of COPD management?

A

ICS alone, OTC cough med, poor or erratic adherence, >1 canister of albuterol/month, frequent ABX or oral steroids, therapeutics duplication

131
Q

What needs to be shaken well for 5 seconded before EACH spray?

A

Symbicort HFA

132
Q

Soft Mist Inhaler for COPD

A

Spiriva Respimat

133
Q

Soft mist inhaler for asthma

A

Spiriva Respimat

Clinical Therapeutics (8 decks)

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