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Therapeutics > COPD > Flashcards

COPD Flashcards

1
Q

COPD definition

A
  • persistent respiratory sx and airflow limitations
  • due to airway and/or alveolar abnormalities
  • dev fibrosis, alveolar wall destruction, and mucus hypersecretion
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2
Q

COPD symptoms

A
  • persistent and progressive dyspnea
  • chronic cough
  • chronic sputum production
  • hx of risk factor exposure
  • family hx
  • hyperinflation
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3
Q

risk factors for COPD

A
  • smoking
  • smoke from cooking/ heating fuels
  • occupational
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4
Q

COPD phenotypes

A
  • chronic bronchitis
  • emphysema
  • asthma- COPD overlap
  • alpha-1 anti-tripsin deficiency (AATD)- hereditary cause
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5
Q

chronic bronchitis

A
  • chronic cough for 3 mo in each of 2 successive years
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6
Q

emphysema

A
  • abnormal permanent enlargement of airspaces distal to terminal bronchioles
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7
Q

markers for hyperinflation

A
  • inspiratory capacity

- functional residual capacity

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8
Q

how do you grade severity of COPD

A
  • GOLD severity rating
  • must have FEV1/ FVC ratio < 70%
  • compare FEV1 ratio to predicted value
  • graded 1-4
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9
Q

GOLD 1

A
  • mild

- FEV1 > 80% predicted

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10
Q

GOLD 2

A
  • moderate

- FEV1 50-80% predicted

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11
Q

GOLD 3

A
  • severe

- FEV1 30-50% predicted

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12
Q

GOLD 4

A
  • very severe

- FEV1 < 30%

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13
Q

COPD exacerbation

A
  • acute worsening of respiratory sx

- requires additional therapy

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14
Q

mild COPD exacerbation tx

A
  • short acting bronchodilator
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15
Q

moderate COPD exacerbation

A
  • short acting bronchodilator PLUS abx/steroids
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16
Q

severe COPD exacerbations

A
  • hospitalization or ED

- possible respiratory failure

17
Q

treatments for exacerbations

A
  • bronchodilators
  • O2 if hypoxic
  • PO or IV steroids- shorten recovery time and improve lung function
  • abx- often get superimposed infections
18
Q

group A exacerbation risk/ sx burden

A
  • 0 hospitalizations
  • 0-1 exacerbations
  • mMRC 0-1 or CAT < 10
  • tx- bronchodilators
19
Q

group B exacerbation risk/ sx burden

A
  • 0 hospitalizations
  • 0-1 exacerbations
  • mMRC 2+ or CAT 10+
  • tx- LAMA or LABA
20
Q

group C exacerbation risk/ sx burden

A
  • 1+ hospitalizations
  • 2+ exacerbations
  • mMRC 0-1 or CAT < 10
  • tx- LAMA
21
Q

group D exacerbation risk/ sx burden

A
  • 1+ hospitalizations
  • 2+ exacerbations
  • mMRC 2+ or CAT 10+
22
Q

goals of treatment

A
  • relieve sx
  • improve exs tolerance
  • improve health status
  • prevent progression
  • prevent exacerbations
  • reduce mortality
  • generally: reduce sx and risk
23
Q

COPD management cycle

A
  • review- sx, exacerbation frequency
  • assess- inhaler technique, adherence, non-pharm approaches
  • adjust- escalate, switch devices, de-escalate
24
Q

general tx considerations for COPD

A
  • inhaled preferred
  • combo tx is better than ICS or LAMA alone
  • SAMA/ SABA for acute exacerbations only
  • maintenance with long acting bronchodilators preferred
25
Q

ICS + LABA combo in COPD

A
  • preferred in pts with asthma- COPD overlap phenotype (eosinophilia)
  • regular tx with ICS increases pneumonia risk
26
Q

non-bronchodilator therapies for COPD

A
  • mucolytics
  • antitussives
  • leukotriene modifiers
  • anti-TNF alpha antibodies
  • alternative therapies
  • vitamin D
  • none have been shown to be very effective
27
Q

red flags of COPD treatment

A
  • ICS alone
  • OTC cough meds
  • poor or erratic adherence
  • missed appointments
  • avoiding ADLs
  • poor technique/ inhaler maintenance
  • > 1 canister of albuterol per month
  • frequent abx or steroids
  • therapeutic duplications
28
Q

COPD treatment for dyspnea

A
  • start with LAMA or LABA
  • step up to LAMA + LABA
  • consider switching drug and/or device, investigate cause of sx
  • if pt has eosinophilia can start with ICS + LABA and step up to triple tx
29
Q

COPD treatment for exacerbations

A
  • LAMA or LABA
  • step up to LAMA + LABA
  • can step up to ICS + LABA if eosinophilia
  • step up to triple therapy, roflumilast, or azithromycin
30
Q

eosinophilia cut offs for ICS use

A
  • eosinophilia > 300

- eosinophilia > 100 and high risk exacerbations

31
Q

respimat steps for use

A
  • soft mist inhaler
  • must push cartridge into inhaler with force
  • hold inhaler upright, turn base until click
  • flip cap and press dose release
32
Q

diskus steps for use

A
  • DPI
  • hold inhaler like hamburger
  • to load slide lever away from you until it clicks
  • breath in forcefully and quickly
33
Q

tudorza pressair steps for use

A
  • DPI
  • requires prep
  • hold inhaler so it “looks like a sneaker”
  • press green button all the way down to release so window turns from red to green
  • breath in quickly and deeply until click
  • check that the window turned back to red
34
Q

ellipta steps for use

A
  • DPI
  • slide cover down to expose mouth piece until click
  • dont block air vent
  • breath in
  • if cover is opened and closed without inhalation dose is lost
  • not possible to inhale 2 doses
35
Q

spiriva handihaler

A
  • separate on blister from blister card and load
  • press green piercing button until flat against base and release
  • hold upright, turn horizontally and breath in
  • capsule should vibrate
  • dont block vents
  • take a SECOND inhale

Therapeutics (5 decks)

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