COPD Flashcards
COPD is the fourth
leading cause of death among adults
COPD is
Persistent respiratory symptoms and
airflow limitation, due to airway and/or
alveolar abnormalities, usually caused by
significant exposure to noxious particles or
gases
COPD is made up of what two conditions
Obstructive bronchiolitis and emphysema
Gold Initiative for Chronic
Obstructive Lung Disease (GOLD) uses what to evaluate severity
• Uses the forced expiratory volume in one
second (FEV1).
• Severity of symptoms, risk of exacerbation,
presence of comorbidities; disease pattern.
• COPD Assessment Tool (CAT) or modified
Medical Research Council (mMRC) dyspnea
scale
• Symptoms and risk components are
combined into four groups.
COPD Managment (5 items)
• Smoking cessation • Reduction of other risk factors (e.g., exposure to open cooking fires) • Vaccinations, • Oxygen therapy • Pulmonary rehabilitation.
Classifications of COPD
– Mild
– Moderate
– Severe
– Very severe
Gold 1 Mild FEV
> 80
Gold 2 Moderate FEV
50 to 79
Gold 3 Severe FEV
30 to 49
Gold 4 Very Severe FEV
<30
Gold ABCD grading
Multidimensional assessment of COPD that uses symptoms and risk of exacerbation
Group A:
Few symptoms; low risk
Group B
Increased symptoms; low risk
Group C
Few symptoms; high risk
Group D
Increased symptoms; high risk
Treatment goals for CPOD
Reduce symptoms, thereby improving the
patient’s health status and exercise tolerance
– Reduce risks and mortality by preventing
progression of COPD and by preventing and
managing exacerbations
COPD all categories should
avoid risk factors such as smoking
flu vaccine
pneumoccal vaccine
regular physical activity
regular review/correction of inhaler technique
long-term oxygen therapy if chronic hypoxemia
pulmonary rehab
Category A Treatment
Minimally symptomatic, low risk of exacerbation
• Short-acting bronchodilator (SABA or anticholinergics)
• Can add a long-acting bronchodilator, if
symptoms inadequately controlled with
short-acting bronchodilator
• Combination therapy (albuterol plus
ipratropium)
Category B Treatment
More symptomatic, but at low risk of exacerbation
• Long-acting bronchodilator (beta agonist or anti-muscarinic agent) • Combined bronchodilator therapy – Triotropium-olodaterol – Umclidiniuum-vilanterol – Glycopyrronium-indacterol
Category C Treatment
Minimally symptomatic on a day-to-day basis
but are at a high risk for an exacerbation
• LAMA (initial)
• Both a LAMA and a long-acting beta agonist
(LABA)
• Both a LABA and an inhaled glucocorticoid
(ICS)
• Less preferred options include regular use of
short-acting beta-agonist and/or short-acting muscarinic agent; a phosphodiesteras-4
inhibitor, or theophylline
Category D
Higher symptom burden and a high risk of
exacerbation
• Triple therapy – GC-LABA-LAMA
COPD approach
Step-wise fashion
– Bronchodilators (beta agonist and anticholinergics)
– Glucocorticoids (inhaled)
– Phosphodiesterase-4 inhibitors
COPD Exacerbation Management
– SABAs (specifically inhaled, either alone or in
combination with inhaled anticholinergics) are
preferred for bronchodilation during COPD
exacerbations
– Systemic glucocorticoids
– Antibiotics
– Supplemental oxygen to maintain an oxygen
saturation of 88% to 92%
Phosphodiesterase-4 Inhibition reduce
Reduce risk of COPD exacerbations in
patients with a history of frequent COPD
Phosphodiesterase-4 Inhibition decrease
• Decreases inflammation and may promote
airway smooth muscle relaxation
• Roflumilast
Phosphodiesterase-4 Inhibition example
Roflumilast
Phosphodiesterase-4 Inhibition may be associated with
May be associated with an increase in
adverse psychiatric reaction, should be used
in caution in patients with a history of
depression.
Phosphodiesterase-4 Inhibition SE
: insomnia, diarrhea, nausea, vomiting,
weight loss, and dyspepsia.
COPD is a
a common condition with a high mortality
• The Global Initiative for Chronic Obstructive Lung Disease
(GOLD) has developed a
categorization system for COPD
severity. Defines disease severity according to the frequency
and severity of symptoms and the risk of exacerbations and
hospitalization. Use this as a guide for the management of
patients with stable COPD. Assess symptoms using the
modified Medical Research Council (mMRC) dyspnea scale
or the COPD Assessment Test (CAT).
For all patients prescribe a
short-acting bronchodilator (e.g., a
beta-agonist, anticholinergic agent) on an as-needed basis for
relief of acute COPD symptoms.
Consider a combination of a
SABA and a short-acting
muscarinic agent to achieve a greater acute bronchodilator
benefit. Those on a long-acting anticholinergic agent, a short- acting beta agonist is generally used for quick relief of COPD
symptoms.
Monitoring
• Routine monitoring of symptoms
Oxygen — long-term supplemental oxygen therapy is recommended for
chronic hypoxemia (PaO2 ≤55 mmHg or SpO2 ≤88 percent).
“Long-term oxygen therapy (LTOT) increases
survival and improves the
quality of life of hypoxemic patients with chronic obstructive pulmonary
disease (COPD) and is often prescribed for other patients with hypoxemic
chronic lung disease” (Tiep, & Carter, 2019).
Comprehensive pulmonary rehabilitation – improves
exercise capacity,
improve quality of life, decrease dyspnea, and decreases health care
utilization.
Phosphodiesterase-4 (PDE-4) inhibitor [roflumilast] - approved to
reduce the
risk of COPD exacerbations in patients with a history of frequent COPD
exacerbations (e.g., at least two per year or one requiring hospitalization)
