COPD

Question 1

Describe SABA use for COPD

Answer 1

• Improves sx, not exacerbations
• Schedule QID then PRN
• Only comes in MDI, so need an aerochamber
• AE = increased nervousness, increased HR, headache

Question 2

Describe LAMA use for COPD

Answer 2

• Decreases exacerbations, hospitalizations, adverse effects, and increases QoL
• Schedule once or twice daily
• AE = dry mouth, cough, constipation

Question 3

Describe LABA use for COPD

Answer 3

• Decreases sx
• Increases QoL and FEV1
• Schedule once or twice daily
• AE = increased HR; similar AEs to SABA, but less substantial

Question 4

Describe COPD exacerbation management

Answer 4

• Exacerbation = acute worsening of sx over more than 48 h
  1. Schedule salbutamol or ipratropium 2 puffs QID and continue maintenance inhalers
  2. Systemic steroids (prednisone 50 mg x 5 days) -> increases FEV1 and decreases tx failure
  3. Antibiotics if change in sputum colour and increased sputum volume or increased dyspnea

Question 5

Drug interactions w/ COPD drugs

Answer 5

LABA –> 3A4 inhibitors may increase AE of salmeterol

Question 6

Red flags for COPD

Answer 6

• Unresponsive to therapy
• Severe and recurrent exacerbations
• Too breathless to leave the house, or breathless when dressing or undressing (this would be severe or very severe COPD)

Question 7

Specific questions to ask for COPD

Answer 7

• How are you using your inhaler?
• Can you show me how you take a puff?
• What are your main symptoms? Have they been getting worse over the past few days?
• Have you had a spirometry?
• Do you have asthma?
• Do you use an aerochamber? (for the MDIs)

Question 8

Non-pharms for COPD

Answer 8

• Smoking cessation
• Vaccinations (annual flu and pneumonia)
• Physical activity
• CVD risk reduction when applicable
• Pulmonary rehab

Question 9

General monitoring for COPD

Answer 9

• Monitor adherence and technique

- SABA and LABA will help w/ sx; LAMA will help w/ QoL

Question 10

General follow-up for COPD

Answer 10

• 2 weeks after starting new inhaler to address technique

- Follow-up regarding smoking cessation (if needed)

Question 11

Describe monitoring for COPD when adding a LAMA

Answer 11

• Monitor for side effects daily and sx improvement weekly
• Not really for sx improvement, more to prevent exacerbations
• Common SE = dry mouth (rinse mouth after inhalation to decrease this), cough, constipation, headache

Question 12

Describe when to go to a Dr for COPD when adding a LAMA

Answer 12

If sx don’t improve within 4 weeks?

Question 13

Describe when to go to emergency for COPD when adding a LAMA

Answer 13

Go to emergency if experiencing an exacerbation (shortness of breath at rest, increased sputum production, change in sputum colour, etc.)

Question 14

Describe non pharms for COPD when adding a LAMA

Answer 14

• Pulmonary rehab
• Smoking cessation
• Vaccinations (flu shot and pneumococcal)
• Avoid triggers (if possible)
• Physical activity

Question 15

Describe follow up for COPD when adding a LAMA

Answer 15

• I will follow up with you 1 week to discuss sx improvement, side effects, and adherence
• Also follow up regarding smoking cessation (if applicable)

Question 16

Describe monitoring for COPD when adding a LABA

Answer 16

• Monitor for sx improvement and side effects daily/weekly
• Used for sx
• Common SE = tremors, increased HR

Question 17

Describe when to go to a Dr for COPD when adding a LABA

Answer 17

Go to doctor if you find that your sx aren’t improving or are getting slightly worse after 4 weeks?

Question 18

Describe when to go to emergency for COPD when adding a LABA

Answer 18

Go to emergency if signs and sx of an exacerbation

Question 19

Describe non pharms for COPD when adding a LABA

Answer 19

• Pulmonary rehab
• Smoking cessation
• Vaccinations (flu shot and pneumococcal)
• Avoid triggers (if possible)
• Physical activity

Question 20

Describe follow up for COPD when adding a LABA

Answer 20

• I will follow up with you 1 week to discuss sx improvement, adherence, and side effect management
• Also follow up regarding smoking cessation (if possible)

Question 21

Describe monitoring for COPD after an exacerbation

Answer 21

• Monitor for exacerbation sx improvement daily

- Continue to monitor other COPD sx daily/weekly

Question 22

Describe when to go to a Dr for COPD after an exacerbation

Answer 22

Go to doctor if sx haven’t improved at all after full course of prednisone (+/- antibiotic) has been properly completed, or if sx have improved slightly but not fully after 3-5 days of completing the regimen

Question 23

Describe when to go to emergency for COPD after an exacerbation

Answer 23

Go to emergency if sx worsen or you have an allergic reaction to prednisone/antibiotic

Question 24

Describe non pharms for COPD after an exacerbation

Answer 24

• Pulmonary rehab
• Smoking cessation
• Vaccinations (flu shot and pneumococcal)
• Avoid triggers (if possible)
• Physical activity

Question 25

Describe follow up for COPD after an exacerbation

Answer 25

• I will follow up with you 3 days to discuss if sx are improving w/ the prednisone (+/- antibiotic)
• Also follow up if they got a new inhaler, or if recommended non-pharms (maybe 1-2 weeks)