COPD Mgmt

Question 1

Where does COPD stand in the cause of death statistics in the USA?

Answer 1

3rd leading COD

Question 2

Prevention: what immunization/s are recommended in guidelines for COPD

Answer 2

23-valent pneumococcal vaccine

Question 3

True or false: 23-Valent Pneumcoccal vaccination prevents acute exacerbation of COPD.

Answer 3

False
Recommended for adults age 19-65 for underlying medical conditions
All adults 65 and older

Question 4

What other immunizations are recommended?

Answer 4

Annual flu shot does help to prevent exacerbation

Question 5

What is the only evidence-based intervention that improves COPD prognosis?

Answer 5

Smoking cessation.
Low evidence for prevention of exacerbation.
Does reduce cough, phlegm in 1st year.
Less lung function decline with sustained cessation.

Question 6

Pulmonary rehabilitation helps prevent acute exacerbation of COPD in what stage of disease?

Answer 6

Moderate, severe, very severe patients with recent exacerbation in the last 4 weeks.
No evidence for >4 weeks post-hospitalization so guideline does not support >/= 4 weeks out to prevent rehospitalization

Improved quality of life, exercise tolerance, dyspnea

Question 7

True or false: Education should include an action plan to prevent exacerbations of COPD.

Answer 7

False: Education and an action plan without case mgmt does not reduce acute exacerbations based on ED visits or hospitalizations over a 12 month period.

Recommend: Written action plan and case mgmt and access to a health-care specialist at least monthly to prevent severe exacerbations.
Insufficient evidence for telemonitoring

Question 8

True or false: Long acting beta2-agonist can help prevent/decrease moderate to severe acute exacerbations in COPD.

Answer 8

True for patients with moderate to severe asthma.
Improved quality of life and lung fct compared to placebo
Long acting muscarinic antagonists also reduce risk of acute exacerbation,QOL and lung fct

Question 9

True or false: LAAC (LAMA) have a higher rate of non-fatal serious adverse events than LABA.

Answer 9

False though newer, longer acting LABA that are once daily not have same a/w adverse event.

Question 10

Which agent, SAMA/SAAC or SABAs, is recommended for monotherapy in the prevention of acute mild to moderate exacerbations, improved QOL and lung function in moderate to severe COPD?

Answer 10

SAMA/SAAC for “risk” of acute exacerbations, QOL and fct.
Fewer adverse reactions
No difference re; hospitalizations

Question 11

True or false: SABA plus LAAC/LAMA reduces acute flare and improves QOL and lung fct at the price of higher risk of adverse events.

Answer 11

False, it does NOT have significant difference compared to individual agents. SABD does have a higher incidence of strokes however.

Question 12

Moderate to severe COPD: LABA monotherapy vs SAAC/SAMA:

Which option reduces acute exacerbations while improving lung function, QOL and dyspnea scores more favorably?

Answer 12

LABA: and no significant differences in ADRs vs. SAAC/SAMA

Question 13

Which is preferred for reduction of acute exacerbations?
A. SAMA plus LABA
B. LAMA plus LABA
C. LABA monotherapy

Answer 13

A

Question 14

What is the recommend maintenance therapy for stable moderate, severe and very severe COPD?

Answer 14

ICS plus LABA
Not ICS monotherapy unlike asthma

slower rate of decline in QOL, lower risk for candidiasis, hoarseness and dysphonia, bruising and pneumonia
Preferred over LABA monotherapy

Question 15

What population with COPD would benefit from long-term use of macrolide?

Answer 15

Moderate to severe COPD
>40 y/o with h/o smoking or current smoking
One or more moderate or severe exacerbations per year
Long-term macrolide therapy
Consider QT interval, hearing loss, bacterial resistance
No data re: dosage or duration

Question 16

When are systemic steroids recommended for mgmt of COPD?

Answer 16

Outpatient or inpatient mgmt of acute exacerbation.
Oral or IV
Prevention of hospitalization or subsequent exacerbation in next 30 days
Not for the sole purpose of prevention: used for treatment of exacerbation

Question 17

True or false: evidence supports use of long-term corticosteroids to reduce acute exacerbation.

Answer 17

False: risks>benefit

Hyperglycemia, weight gain, infection, osteoporosis,adrenal suppression

Question 18

Roflumilast is recommended for prevention acute exacerbations for what category of COPD patients?

Answer 18

Chronic bronchitis with h/o at least one exacerbation in past year.
ADR: diarrhea, weight loss
Limited data re: effectiveness in patients already on inhaled therapies
Theophylline, slow-released, twice daily for patients with continued periodic exacerbations
Smoking impacts theophylline levels

Question 19

True or false: Oral N-acetylcysteine may be used in patient with 2 or more exacerbations per year to reduce risk of exacerbation.

Answer 19

True
For patients on maintenance therapy with BD and ICS
Low risk for ADRs