COPD

Question 1

why is COPD the only common cause of death thats increased in prevelance over the last 40 years

Answer 1

no medications that decrease mortality

Question 2

COPD vs asthma age of onset

Answer 2

asthma young

copd over 40

Question 3

copd vs asthma smoking history

Answer 3

copd usually smokers

Question 4

copd vs asthma sputum production

Answer 4

infrequent with asthma

often with copd

Question 5

copd vs asthma allergies

Answer 5

allergies common in asthma not copd

Question 6

copd vs asthma clinical symptoms

Answer 6

asthma intermittent and variable

copd persistent

Question 7

copd vs asthma disease course

Answer 7

asthma stable with exacerbations and spirometry normalizes

copd is progressive worsening will never normalize

Question 8

what are some reversible tings in copd

Answer 8

presence of mucus and inflammatory cells and mediators in bronchial secretions
bronchial smooth muscle contraction in peripheral and central airways
dynamic hyperinflation during exercise

Question 9

what are some irreversible things in copd

Answer 9

fibrosis and narrowing of airways
reduced elastic recoil with loss of alveolar surface area
destruction of alveolar support with reduced patency of small airways

Question 10

what is the most effective wat to reduce decline in lung function

Answer 10

stop smoking

Question 11

diagnosis of copd

Answer 11

post bronchodilator FEV1/FVC ratio of 70%

Question 12

what is mild copd

Answer 12

SOB when hurrying or walking up a slight hill
FEV >80%
FEV/FVC

Question 13

what is moderate copd

Answer 13

SOB causes patient to stop after walking 100m level
5080 predicted
FEV/FVC

Question 14

what is severe copd

Answer 14

SOB prevents patient from leaving the house
breathless when dresing

30

Question 15

treatment for mild copd

Answer 15

SABA as needed

Question 16

treatment of worsening mild copd

Answer 16

add a LAMA or LABA to the SABA

Question 17

if a LABA or LAMA alone does not work what is the next step

Answer 17

LAMA/LABA combo

Question 18

treatment for asthma copd overlap

Answer 18

ICS and LABA

if uncontrolled add LAMA or increase dose

Question 19

important patient outcomes

Answer 19

QOL 
dyspnea scores
rescue inhaler use
walking disance
exacerbations
mortality

Question 20

what is statistical sig

Answer 20

establishing the difference shown is not due to chance

Question 21

what is clinical sig

Answer 21

is the result sig to the patient

Question 22

on the SGRQ quality of life questionnare how many points are clinically sig

Answer 22

4 points

Question 23

what is a simple exacerbation

Answer 23

< 4 in a year and at least 2 of:

increased sputu, purulence or volume and or increased dyspnea

Question 24

treatment for a simple exacerbation

Answer 24

amox
doxycyline
sulfatrim
5-7 days

Question 25

whats a complicated exacerbation

Answer 25

``` >4 and at least 2 of: 1. increased sputum purulence 2. increased sputum volume 3. increased dyspnea failure of first line agents antibiotics in the past 3 months ```

Question 26

treatment for complicated exacerbation

Answer 26

amox clav cefuroxime levo alternative: azithro, clarithro

Question 27

how is prednisone used in acute exacerbations

Answer 27

50mg for 5 days (just as good as 14 days) | increases FEV1 and decreases treatment failure

Question 28

do you need to taper prednisone after a 2 week use

Answer 28

no

Question 29

side efffects of tiotropium

Answer 29

dry mouth

Question 30

side effects of salmeterol

Answer 30

tremor, increase HR, nervous

Question 31

is a LAMA or LABA better?

Answer 31

LAMA may be a tiny bit better but CPG recommends either one comes down to the patient preference

Question 32

examples of LAMAs

Answer 32

glycopyrronnium tiotropium aclidinium umeclidinium

Question 33

new LAMAs compared to tiotropium

Answer 33

no difference just depends what type of inhaler they prefer

Question 34

does tiotropium really reduce hospitalizations by 30% more than glycopyrronium?

Answer 34

30% is a relative number not absolute only 0.04 hospitalizations so there is no difference

Question 35

LABA options

Answer 35

indacaterol formoterol salmeterol

Question 36

mechanism of the LAMA LABA combo

Answer 36

relax airway smooth muscle by direct inhibition of cholinergic activity and antagonism of bronchoconstriction via beta 2 adrenergic pathways

Question 37

what is transition dyspnea index and how many points would you want it to change

Answer 37

evaluative instrument that measures changes in dyspnea compared to baseline 3 for clinical sig

Question 38

is a LAMA LABA combo better than on their own

Answer 38

may prevent 1 exacarbation but no difference in hospitalizations not overal much of a benefit but no increase in adverse events

Question 39

if combo was successful what would you do

Answer 39

combo inhaler because cheaper than 2 separate inhalers

Question 40

if combo is not successful what do you do

Answer 40

check in 4 weeks if not successful stop

Question 41

what is pulmonary rehab and whats it for

Answer 41

multidisciplinary team that educates/trains/counsels/supports for 6-8 week - smoking cessation, exercise, nutrition, physcosocial any patient with disabling copd symptoms

Question 42

benefits of pulmonary rehab

Answer 42

improve dyspnea and quality of life seen in sizes beyond clinical sig improve hospitalization and mortality

Question 43

what do you give if someone is uncontrolled on LAMA LABA combo

Answer 43

LAMA + ICS/LABA | insufficient evidence that there is any additional benefit

Question 44

why is LAMA + LABA preferred over ICS + LABA

Answer 44

LAMA LABA modestly better and is safer | ICS and LABA causes pneumonia in these patients

Question 45

does removing fluticasome from the lama and laba cause mroe exacerbations

Answer 45

no cant justify used for ICS in COPD unless that have asthma

Question 46

non pharms

Answer 46

``` pneumococcal and influenza shot smoking cessation pulmonary rehab CVD risk reducation track adherence and technique ```

Question 47

if someone was on ICS already what would be good indications to stop

Answer 47

no additional benefit in a yea or had several peumonias