COPD Flashcards
Symptoms of COPD
Shortness of breath
Chronic cough
Sputum
COPD risk factors
Tobacco
Occupation
Indoors and outdoor pollution
Host-factors
What is required to establish diagnosis of COPD
Spirometry
Dyspiea with COPD
Progressive over time
Worse during exercise
Persistent
Chronic cough with COPD
Maybe intermittent and unproductive
Presents with recurrent wheezing
Chronic sputum production and COPD
Any form may indicate COPD
Recurrent lower respiratory tract infection
Indicates COPD
History of Risk factors
Genetic factors
Congenital or developmental abnormalities
Tobacco
Smoke from other source
Occupational dust, fumes, gases, vapors and other chemical
Family history or childhood factors
Low birth weight
Childhood respiratory infection
Mild severity of COPD
FEV1 ≥ 80% predicted
Moderate severity
50% ≤ FEV1 ≤ 80% predicted
Severe severity
30% ≤ FEV1 ≤ 50% predicted
Very severe severity
FEV1 < 30% predicted
mMRC grade 0
Out of breath with strenuous exercise
mMRC grade 1
Speed walking on a leveled ground or walking up a slight hill
mMRC grade 2
Walker slower than age group because of breathlessness
Or
Stop to catch a breath when walking at pace on a leveled ground
mMRC grade 3
Catch breath after 100 meters or few minutes while walking on a leveled ground
mMRC grade 4
Too breathless to leave the house or depressing or undressing
0 or 1 hospitalization
mMRC 0-1
CAT < 10
Group A
0 or 1 hospitalization
mMRC ≥ 2
CAT ≥ 10
Group B
≥ 2 or ≥ 1 hospitalization
mMRC 0-1
CAT < 10
Group C
≥ 2 or ≥ 1 hospitalization
mMRC ≥ 2
CAT ≥ 10
Group D
What are the non pharmacological therapy for COPD
Smoking cessation
Vaccination
Pulmonary rehabilitation
Physical activity
Appropriate inhaler technique and adherence
Group A initial treatment
Bronchodilator
Group B initial treatment
LAMA or LABA
Group C initial treatment
LAMA
Group D initial treatment
LAMA
or
LAMA + LABA
or
ICS + LABA
What immediate relief therapy should all COPD Patient be offered
short acting bronchodilator
SAMA + SABA
Group A explained
Few symptom and low exacerbation risk
Short or long acting bronchodilator offered and continued if benefit is observed
Group B explained
More symptoms and low risk of exacerbation
LAMA or LABA
Group C explained
Few symptoms and high risk of exacerbation
LAMA preferred
Group D explained
Frequent symptoms and high risk of exacerbation
LAMA
If CAT > 20 LAMA + LABA
If eosinophils > 300 or history of asthma LABA + ICS
SABA: Albuterol dosing
90 mcg
2 inhalation q 4-6 hours prn
Onset: 4-6 hours
SABA: Levalbuterol
45-90 mcg
2 inhalation q 4 hours prn
Onset: 6-8 hours
12 hours or twice daily dosing LABA
Formoterol
Arformoterol
Salmeterol
24 hours or once daily dosing LABA
Indacaterol
Olodaterol
SAMA
Ipatropium bromide
2 inhalation q 6 hours
Duration: 6-8 hours
12 hours LAMA or twice daily dosing
Aclinidium Bromide
2 inhalation BID
Glycopyrronium bromide
1 capsule inhaled BID
24 hours or once daily dosing LAMA
Tiotropium
Umeclidinium
Antimuscarinic ADR
ANTI-SLUD
True/False: LAMA and SAMA can be administered together
False
Use of ICS-LABA has strong support for which group
Group D
History of hospitalization and exacerbation
≥2 COPD moderate exacerbation per year
Eosinophils > 300 cells/ul
History of asthma
ICS-LABA should be considered for use in which patient group
1 moderate exacerbation per year
Blood eosinophils 100-300 cells/ul
What patient group should not use ICS-LABA
Repeated pneumonia event
Eosinophils < 100 cells/ul
History of mycobacterial infection (TB)
12 hours or twice daily dosing LABA + ICS
Symbicort
Dulera
Advair
24 hours or once daily dosing LABA + ICS
Breo Ellipta
24 hours or once daily dosing LABA + LAMA + ICS
Trelegy Ellipta
Draw the follow up chart for COPD pharmacological treatment for exacerbation and dyspnea
On notability
When do you discontinue inhaled corticosteroids in patients with COPD
Active or risk of pneumonia
What is exacerbation
Acute worsening of respiratory symptoms that require an addition therapy
How is mild exacerbation managed
Short acting bronchodilator
How is moderate exacerbation managed
Short acting bronchodilator + antibiotic with or without oral corticosteroids
How is severe exacerbation managed
Hospitalization
What can trigger COPD exacerbation
Viral infection
Bacterial infection
Environmental factors
Ambient temperature
Cord exacerbation characteristics
Increased sputum production ( Purulence and volume)
Increased cough
Now Lang does exacerbation symptoms last
7-10 days
How can COPD exacerbation be managed pharmacologically
Bronchodilators
• Increase doses/frequencies of SABD
• Combine SABA and SAMA
• Consider using LABD when patient is stable
• Use spacers/nebulizers when appropriate
• Use oral corticosteroids (5-7 days)
• Consider oral antibiotics when signs of bacterial infection present (5-7 days)
• Increased sputum production, increased sputum purulence, increased dyspnea
• Consider non-invasive mechanical ventilation (CPAP/BiPAP/etc.)
What is Roflumilast
PDE-4 inhibitor
Dose once daily by mouth 500 mcg
When is azithromycin used
Prevent COPD exacerbation
250mg daily or 250-500 mg 3x weekly
