COPD therapeutic treatment algorithm

Question 1

3 main components of COPD

Answer 1

chronic bronchitis
emphysema
inflammation

Question 2

what is emphysema

Answer 2

abnormal enlargement of the airspace accompanied by destruction of alveolar walls

Question 3

structural changes associated with emphysema

Answer 3

alveolar destruction and reduced elasticity

Question 4

what is chronic bronchitis and what are the structural changes associated with it

Answer 4

Presence of cough and sputum production for atleast 3 months in each of the two consecutive years.

structural changes include airway narrowing due to fibrosis and smooth muscle inflammation

Question 5

KEY concepts of COPD

Answer 5

preventable
non-reversible
progressive persistent airflow limitation

Question 6

what are the 3 hallmark symptoms of COPD

Answer 6

chronic cough, sputum production, dyspnea

Question 7

COPD signs

Answer 7

increased respiratory rate
decreased breath sounds
prolonged expiration
hyperinflation
lips pursing on expiration

Question 8

What is required to diagnose COPD

Answer 8

spirometry

Question 9

What confirms airflow limitation

Answer 9

FEV/FVC<0.7

Question 10

What are some common causes for COPD exacerbations

Answer 10

respiratory tract infection
(viral, bacterial) viral more common
air pollution
1/3 are unknown

Question 11

what are some treatment options for COPD

Answer 11

SABA (albuterol) with or without ipratropium
systemic corticosteroid- prednisone 40 mg for 5 days
Antibiotics- must have cardinal symptoms

Question 12

what are the 3 cardinal symptoms that would require antibiotic use

Answer 12

sputum purulence
sputum volume
dyspnea

sputum purulence is a requirement and must have 2/3 symptoms

Question 13

discharge criteria for COPD

Answer 13

clinically stable for 12-24 hours
inhaled SABA not required more than every 4 hours
patient is able to walk across the room
able to use LABA

Question 14

spirometric classifications of COPD

Answer 14

GOLD 1 FEV 80 and above
GOLD 2 FEV between 50 and 79
GOLD 3 30 to 49
GOLD 4 29 and below

Question 15

group with more symptoms are in _______ and __________

Answer 15

B and D

Question 16

Groups with more exacerbations are in ____ and _________

Answer 16

C and D

Question 17

symptom assessment mMRC grades

Answer 17

mMRC 0- only get breathless with strenuous exercise

mMRC 1- SOB when walking up a hill

mMRC 2- walk slower than people of the same age due to breathlessness

mMRC 3- stops for breath after 100 meters

mMRC- too breathless to leave house

Question 18

where are patients grouped in (A, B, C, D) according to CAT and mMRC

Answer 18

CAT 10 and up and mMRC greater than 1 is grouped B and D

CAT less than 10 and mMRC 0-1 is grouped A and C

Question 19

Where are patients grouped based on exacerbations and hospitalizations (A,B,C,D)

Answer 19

0-1 exacerbations is A or B
2 and up is C or D
Any hospitalization is C or D

Question 20

Initial treatment for each Group (except D)

Answer 20

Group C- LAMA
Group A- bronchodilator
Group B- LABA or LAMA

Question 21

initial treatment for group D

Answer 21

LAMA
LAMA/LABA if CAT is greater than 20
ICS/LABA if eosinophil count is more than 300 cells/ul or
If more than 100 cells/ul and 2 or more exacerbations
or 1 hospitalization

Question 22

How to get dyspnea under control in COPD

Answer 22

If COPD being treated by LABA or LAMA, just add the other one. (LABA+LAMA)

Question 23

If patient sees no changes in results with ICS+LABA switch to

Answer 23

ICS+LABA+LAMA

Question 24

When to use roflumilast in COPD

Answer 24

FEV 1 less than 50 percent and bronchitis (add azithro for former smokers)

Question 25

step by step treatment of COPD

Answer 25

1. LAMA or LABA
2. LAMA & LABA or LABA +ICS
3. if eosinophil is 100 or more use LABA + LAMA + ICS
4. if FEV1 less than 50 use roflumilast
   use azithro in former smokers

Question 26

When to use ICS