COPD Part 3

Question 1

Pharmacotherapy

Answer 1

Bronchodilators
Corticosteroids

Others:
alpha1antitrypsin augmentation therapy, antibiotic agents, mucolytic agents, antitussive agents, vasodilators, and opioids

Vaccines:
influenza vaccines, Pneumococcal vaccination

Question 2

grade I (mild) COPD

Answer 2

short-acting bronchodilator

Question 3

grade II or III (moderate or severe)

Answer 3

short-acting bronchodilator and regular treatment with one or more long-acting bronchodilators

Question 4

grade III or IV (severe or very severe) COPD

Answer 4

regular treatment with long-acting bronchodilators and/or inhaled corticosteroids (ICSs) for repeated exacerbations

Question 5

are key for symptom management in stable COPD

Answer 5

Bronchodilator

Question 6

are more convenient for patients to use, typically used for maintenance treatment for long-term symptom control

Answer 6

Long-acting bronchodilators

Question 7

are usually used for acute management of symptomatic flairs.

Answer 7

Short-acting bronchodilators

Question 8

relieve bronchospasm by improving expiratory flow through widening of the airways and promoting lung emptying with each breath.

Answer 8

Bronchodilator

Question 9

These medications alter smooth muscle tone and reduce airway obstruction by allowing increased oxygen distribution throughout the lungs and improving alveolar ventilation

Answer 9

Bronchodilator

Question 10

Bronchodilators can be delivered through

Answer 10

pressurized metered-dose inhaler (pMDI), a dry-powder inhaler (DPI), by a small-volume nebulizer (SVN), or via the oral route in pill or liquid form

Question 11

are small handheld devices that may be carried in a pocket or purse

Answer 11

pMDIs and DPIs

Question 12

is an excellent health care provider to consult on appropriate inhaler technique

Answer 12

respiratory therapist

Question 13

Pressurized metered-dose inhalers (pMDIs) types

Answer 13

Conventional and breath-actuated

Question 14

They are pressurized devices that contain aerosolized powder of medications.

Answer 14

pMDIs

Question 15

may also be indicated to enhance deposition of the medication in the lung and help the patient coordinate activation of the pMDI with inspiration

Answer 15

spacer or valved-holding chambers

Question 16

are designed so that they require coordination between the patient’s inspiration and the mechanics of the inhaler

Answer 16

pMDIs

Question 17

rely solely on the patient’s inspiration for medication delivery, do not require the coordination necessary to administer pMDIs

Answer 17

dry-powder inhalers (DPIs)

Question 18

is a handheld apparatus that is easier
to use than a pMDI or a DPI but lacks the convenience of these inhalers as it requires a power source in order to operate

Answer 18

small-volume nebulizer (SVN)

Question 19

Common SVNs include

Answer 19

single-use pneumatic jet nebulizers with reservoir tubes

Question 20

which are most commonly used in hospitals, and electronic nebulizers, which may be used in the home-based setting. are commonly prescribed when patients are challenged with being able to administer their medications through either a pMDI or a DPI

Answer 20

single-use pneumatic jet nebulizers with reservoir tubes

Question 21

is a helpful technique to prepare for proper use of the SVN.

Answer 21

Diaphragmatic breathing

Question 22

Several classes of bronchodilators are used that include

Answer 22

beta-adrenergic agonists, muscarinic antagonists (anticholinergics) and combination agents

Question 23

Beta-adrenergic agonists include

Answer 23

short-acting beta-2-adrenergic agonists (SABAs) and
long-acting beta-2 adrenergic agonists (LABAs)

Question 24

anticholinergic agents include

Answer 24

short-acting muscarinic antagonists (SAMAs) and
long-acting muscarinic antagonists (LAMAs)

Question 25

may also be combined with bronchodilators. These medications may be used in combination to optimize bronchodilation

Answer 25

ICSs

Question 26

have become the foundation for treating COPD. Combining these classes of medications in one inhaler has synergistic effects,

Answer 26

Fixed dose combinations of LABAs and LAMAs

Question 27

are more convenient for patient use as compared to shortacting beta2-agonist bronchodilators

Answer 27

LABAs

Question 28

is associated with less adverse reactions and promotes proper medication administration by avoiding the use of multiple inhaler devices

Answer 28

combination therapy

Question 29

may improve the symptoms of COPD, they do not slow the decline in lung function

Answer 29

inhaled and systemic corticosteroids

Question 30

Long-term treatment with oral corticosteroids is not recommended in COPD and can cause

Answer 30

steroid myopathy, leading to muscle weakness, decreased ability to function, and, in advanced disease, respiratory failure

Question 31

may be prescribed for patients to determine whether pulmonary function improves and symptoms decrease

Answer 31

short trial course of oral corticosteroids

Question 32

Treatment of COPD with combination of these in one inhaler may improve lung function

Answer 32

long-term beta2-agonists plus corticosteroids

Question 33

Examples of long-term beta2-agonists plus corticosteroids

Answer 33

formoterol/budesonide, vilanterol/fluticasone furoate, and salmeterol/fluticasone.

Question 34

reduces the incidence of community-acquired pneumonia in the general older adult population

Answer 34

Pneumococcal vaccination

Question 35

can reduce serious illness and death in patients with COPD. It is recommended that people limit their risk

Answer 35

influenza vaccination and smoking cessation

Question 36

is defined as an event in the natural course of the disease characterized by acute changes (worsening) in the patient’s respiratory symptoms beyond the normal day-to-day variations

Answer 36

exacerbation of COPD

Question 37

Signs During an exacerbation

Answer 37

increased dyspnea that is a result of amplified hyperinflation and air trapping

Question 38

Primary causes of an acute exacerbation are usually related to

Answer 38

viral infections, particularly human rhinovirus (i.e., the common cold)

bacterial infections and environmental factors

Question 39

may be used as a treatment to reduce the risk of exacerbations in patients with severe COPD associated with chronic bronchitis and a history of exacerbations.

Answer 39

Roflumilast, selective phosphodiesterase-4 (PDE4) inhibitor

Question 40

is first-line therapy and involves identifying the best medication or combinations of medications taken on a regular schedule

Answer 40

bronchodilator medications

Question 41

Depending on the signs and symptoms these meds may also be used

Answer 41

corticosteroids, antibiotic agents, oxygen therapy, and intensive respiratory interventions

Question 42

When the patient with an exacerbation of COPD arrives in an ED, the first
line of treatment is

Answer 42

supplemental oxygen therapy and rapid assessment to determine if the exacerbation is life-threatening

Question 43

are recommended in the hospital management of a COPD exacerbation

Answer 43

Oral or intravenous (IV) corticosteroids, in addition to bronchodilators

Question 44

may be used to assess response to treatment

Answer 44

short-acting inhaled bronchodilator

Question 45

administration of antibiotics remains controversial, but in general, they should be administered when the patient has three cardinal symptoms of an exacerbation:

Answer 45

increase in dyspnea, increase in sputum volume, and sputum purulence