COPD Pharmacotherapy in Older Adults

Question 1

What is the initial maintenance treatment step for COPD?

Answer 1

LAMA+LABA (LAMA have greater effect on reducing exacerbation risk)

preferred over shorter acting agents

Question 2

Name LAMA only medications for COPD?

Answer 2

Tiotropium
Aclidinium
Glycopyrronium
Umeclidinium

Question 3

Name LABA only medications for COPD?

Answer 3

Salmeterol
Formoterol
Indacaterol

Question 4

Name LAMA/LABA combination drugs for COPD?

Answer 4

Umeclidinium+Vilanterol
Glycopyrronium + Indacaterol
Tiotropium + Olodaterol
Aclidinium + Formoterol

LAMA/LABA combination is superior to either LAMA or LABA alone

Question 5

When is ICS added to COPD treatment?

Answer 5

Used in severe disease to reduce exacerbations. Use is limited by increased risk of pneumonia

Question 6

What drug classes are used as rescue medications for COPD?

Answer 6

prn use of SABA and/or SAMA

Question 7

What are some types of SABA only formulations used for rescue in COPD?

Answer 7

Salbutamol
Terbutaline

Question 8

What SAMA only formulation is used for rescue in COPD?

Answer 8

Ipratropium

Question 9

What SAMA/SABA formulation is used for rescue in COPD?

Answer 9

Salbutamol+Ipratropium

Question 10

Antibiotics used in AECOPD in low risk patients?

Answer 10

amoxiciilin TID x 7-10d
doxycycline BID x 7-10d
TMP/SMX BID x 7-10d
clarithromycin BID x 5-10d
azithromycin OD x 5d
cefuroxime BID x 5-10d
cefprozil BID x 5-10d

Question 11

Antibiotics used in AECOPD in high risk patients?

Answer 11

amoxi-clav BID x 5-10d
levofloxacin OD x 5d
moxifloxacin OD x 5-10d

Question 12

What are the characteristics of high infection risk patients having a AECOPD?

Answer 12

Severe COPD (FEV1 is below 50%)
Coronary artery disease
Chronic oral corticosteroid use
More than four exacerbations annually
Use of home oxygen
Antibiotics used in the last 3 months