COPD managment

Question 1

GOLD 1 airflow limitation

Answer 1

FEV1 > 80% predicted

Question 2

GOLD 2 airflow limitation

Answer 2

FEV1 50-80% of predicted

Question 3

GOLD 4 airflow limitation

Answer 3

FEV1 <30% of predicted

Question 4

GOLD 3 airflow limitation

Answer 4

FEV1 30-50% of predicted

Question 5

Add mMRC Grades

Question 6

Mild exacerbation Tx

Answer 6

only with SABA

Question 7

Moderate exacerbation Tx

Answer 7

SABA plus oral antibiotics or OCS

Question 8

what is the benefit of oral corticosteroid’s in COPD?

Answer 8

Helps to improve lung function, oxygenation and reduce recovery time.

Question 9

Severe exacerbation treatment

Answer 9

Hospitalization with or without resp. failure. May need NIV (very beneficial), intubation/ventilation.

Question 10

Group A combined assesment

Answer 10

Low risk low symptoms
- GOLD 1 or 2
- mild to moderate airflow limitation
- 0-1 exacerbations per year
- mMRC 0-1
- CAT <10

Question 11

Group B combined assessment

Answer 11

Low risk more symptoms
- GOLD 1 or 2
- mild to moderate airflow limitation
- 0-1 exacerbations per year
- mMRC 2-4
- CAT >10

Question 12

Group C combined assessment

Answer 12

High risk less symptoms
- GOLD 3 or 4
- Severe to very severe airflow limitation
- >2 exacerbations/yr
- mMRC 0-1
- CAT<10

Question 13

Group C combined assessment

Answer 13

High risk less symptoms
- GOLD 3 or 4
- Severe to very severe airflow limitation
- >2 exacerbations/yr
- mMRC 0-1
- CAT<10

Question 14

Group D combined assessment

Answer 14

High risk More symptoms
- GOLD 3 or 4
- Severe or very severe airflow limitation
- >2 exacerbations per year
- mMRC 2-4
- CAT>10

Question 15

Group A treatment

Answer 15

short acting bronchodilator
ex) ventolin (salbutamol) atrovent (ipatropium)

Question 16

Group B treatment

Answer 16

LAMA or LABA

ex) serevent (salmeterol) or Spiriva (tiotropium)

Question 17

Group C treatment

Answer 17

LAMA - better effect at reducing exacerbations

ex) spiriva (tiotropium)

Question 18

Group D treatment

Answer 18

LAMA or LAMA/LABA

Add ICS to either of these (LABA/ICS or triple) if eosinophil count is >300 or >100 with recent hospitalization

Question 19

When to add PDE4 inhibitor

Answer 19

when eosinophil levels are <100 and triple therapy is not effective

Question 20

Triple inhaled therapy

Answer 20

LABA/LAMA taken with ICS

Question 21

What can be done for a Pt who develops further exacerbations on LABA/LAMA

Answer 21

escalation to LABA/LAMA/ICS
add a PDE4 inhibitor or antiobiotiuc such as azithromin if blood eosinophil <100 cell/ul

Question 22

what is AECOPD

Answer 22

DEFINED BY gold as an acute worsening of resp symptoms that resuly in requirment for additional therapy

Question 23

What can prevent/ treat exacerbation

Answer 23

• NIV
• Antibiotics when indicated (duration= 5-7 days)
• Treat underlying causes.

Question 24

how long do AECOPD symptoms usually last

Answer 24

7- 10 days some longer

• contribute to disease progression

Question 25

Purulent discharges indicate what?

Answer 25

Infection (Evidence that the body response has started to destroy bacteria)