COPD Flashcards
why is COPD the only common cause of death thats increased in prevelance over the last 40 years
no medications that decrease mortality
COPD vs asthma age of onset
asthma young
copd over 40
copd vs asthma smoking history
copd usually smokers
copd vs asthma sputum production
infrequent with asthma
often with copd
copd vs asthma allergies
allergies common in asthma not copd
copd vs asthma clinical symptoms
asthma intermittent and variable
copd persistent
copd vs asthma disease course
asthma stable with exacerbations and spirometry normalizes
copd is progressive worsening will never normalize
what are some reversible tings in copd
presence of mucus and inflammatory cells and mediators in bronchial secretions
bronchial smooth muscle contraction in peripheral and central airways
dynamic hyperinflation during exercise
what are some irreversible things in copd
fibrosis and narrowing of airways
reduced elastic recoil with loss of alveolar surface area
destruction of alveolar support with reduced patency of small airways
what is the most effective wat to reduce decline in lung function
stop smoking
diagnosis of copd
post bronchodilator FEV1/FVC ratio of 70%
what is mild copd
SOB when hurrying or walking up a slight hill
FEV >80%
FEV/FVC
what is moderate copd
SOB causes patient to stop after walking 100m level
5080 predicted
FEV/FVC
what is severe copd
SOB prevents patient from leaving the house
breathless when dresing
30
treatment for mild copd
SABA as needed
treatment of worsening mild copd
add a LAMA or LABA to the SABA
if a LABA or LAMA alone does not work what is the next step
LAMA/LABA combo
treatment for asthma copd overlap
ICS and LABA
if uncontrolled add LAMA or increase dose
important patient outcomes
QOL dyspnea scores rescue inhaler use walking disance exacerbations mortality
what is statistical sig
establishing the difference shown is not due to chance
what is clinical sig
is the result sig to the patient
on the SGRQ quality of life questionnare how many points are clinically sig
4 points
what is a simple exacerbation
< 4 in a year and at least 2 of:
increased sputu, purulence or volume and or increased dyspnea
treatment for a simple exacerbation
amox
doxycyline
sulfatrim
5-7 days
whats a complicated exacerbation
>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
treatment for complicated exacerbation
amox clav
cefuroxime
levo
alternative: azithro, clarithro
how is prednisone used in acute exacerbations
50mg for 5 days (just as good as 14 days)
increases FEV1 and decreases treatment failure
do you need to taper prednisone after a 2 week use
no
side efffects of tiotropium
dry mouth
side effects of salmeterol
tremor, increase HR, nervous
is a LAMA or LABA better?
LAMA may be a tiny bit better but CPG recommends either one comes down to the patient preference
examples of LAMAs
glycopyrronnium
tiotropium
aclidinium
umeclidinium
new LAMAs compared to tiotropium
no difference just depends what type of inhaler they prefer
does tiotropium really reduce hospitalizations by 30% more than glycopyrronium?
30% is a relative number not absolute only 0.04 hospitalizations so there is no difference
LABA options
indacaterol
formoterol
salmeterol
mechanism of the LAMA LABA combo
relax airway smooth muscle by direct inhibition of cholinergic activity and
antagonism of bronchoconstriction via beta 2 adrenergic pathways
what is transition dyspnea index and how many points would you want it to change
evaluative instrument that measures changes in dyspnea compared to baseline
3 for clinical sig
is a LAMA LABA combo better than on their own
may prevent 1 exacarbation but no difference in hospitalizations
not overal much of a benefit but no increase in adverse events
if combo was successful what would you do
combo inhaler because cheaper than 2 separate inhalers
if combo is not successful what do you do
check in 4 weeks if not successful stop
what is pulmonary rehab and whats it for
multidisciplinary team that educates/trains/counsels/supports for 6-8 week - smoking cessation, exercise, nutrition, physcosocial
any patient with disabling copd symptoms
benefits of pulmonary rehab
improve dyspnea and quality of life
seen in sizes beyond clinical sig
improve hospitalization and mortality
what do you give if someone is uncontrolled on LAMA LABA combo
LAMA + ICS/LABA
insufficient evidence that there is any additional benefit
why is LAMA + LABA preferred over ICS + LABA
LAMA LABA modestly better and is safer
ICS and LABA causes pneumonia in these patients
does removing fluticasome from the lama and laba cause mroe exacerbations
no cant justify used for ICS in COPD unless that have asthma
non pharms
pneumococcal and influenza shot smoking cessation pulmonary rehab CVD risk reducation track adherence and technique
if someone was on ICS already what would be good indications to stop
no additional benefit in a yea or had several peumonias
