COPD Therapy

Question 1

pink skin, pursed lips, weight loss, difficulty breathing, rapid breathing are signs of?

Answer 1

emphysema

Question 2

blue lips, white/yellow/green sputum, chronic cough, edema, pulmonary hypertension are signs of?

Answer 2

chronic bronchitis

Question 3

pulmonary function test is used for?

Answer 3

testing lung capacity, rate of flow, and gas exchange

Question 4

define FEV1

Answer 4

forced expiratory volume in one second

Question 5

define FVC
define FEV1/FVC ratio

Answer 5

forced vital capacity; total volume of air a pt can exhale during maximal effort
percentage of FVC expired in first second

Question 6

COPD requires spirometry to be diagnosed, how do we diagnose using spirometry?

Answer 6

post-bronchodilator FEV1/FVC <70 = COPD

Question 7

according to GOLD standards, what percentage of FEV1 indicates mild-very severe COPD

Answer 7

80 or more = mild
50-79 = moderate
30-49 = severe
30 or less = very severe

Question 8

all COPD patients should be considered testing for?

Answer 8

AAT deficiency

Question 9

which test for COPD is recommended by GOLD?

Answer 9

CAT

Question 10

a patient with a CAT score 30 or more indicates?
20 or more?
10-20?
less than 10?

Answer 10

referral, pulm rehab
referral, pulm rehab
optimize meds, minimize aggravating factors
optimize meds, minimize aggravating factors

Question 11

if pt is experiencing exacerbations that require hospitalization, what is the recommended pharm. treatment?

Answer 11

LABA + LAMA

Question 12

if pt is not at risk of hospitalization and CAT is less than 10, what is the recommended pharm treatment? what if it’s 10 or higher?

Answer 12

a bronchodilator
LABA + LAMA

Question 13

what are the two SABAs?

Answer 13

albuterol (proair, ventolin, proventil) and levalbuterol (xopenex)

Question 14

what is the name of the SAMA? what is the condition of using it?

Answer 14

ipratropium bromide (atrovent)
should be used in combo with albuterol

Question 15

what do we call the inhaler that is albuterol/ipratroprium?

Answer 15

combivent, duoneb

Question 16

what are the LABAs? should they be combined with other inhalers for COPD?

Answer 16

formoterol, salmeterol (serevent diskus)
not required, but use with ICS if asthma present

Question 17

what are the LAMAs?

Answer 17

aclidinium, tiotropium (spiriva respimat)
umeclidinium (incruse ellipta)

Question 18

what are the LABA + LAMAs? why do we use them?

Answer 18

formoterol/glycopyrronium (bevespi)
vilanterol/umeclidinium (anoro ellipta)
olodaterol/tiotropium (stioltyo respimat)
they increase FEV1 and reduce symptoms better than monotherapy

Question 19

what are the LABA + ICSs? why do we use them?

Answer 19

formoterol/budesonide (symbicort)
formoterol/mometasone (dulera)
salmeterol/fluticasone (advair, wixela, airduo)
vilanterol/fluticasone (breo ellipta)
preferred with both COPD and asthma

Question 20

do we use theophylline for COPD? (a methylxanthine)

Answer 20

no

Question 21

when would be consider using ICS before LAMA/LABA?
when should we not use ICS?

Answer 21

if eosinophil count is over 300 or pt has asthma
repeated pneumonia events or history of infection

Question 22

which drug class is best for COPD?

Answer 22

LAMAs

Question 23

how do we taper someone off of an ICS?

Answer 23

decrease dose by 50% for 6 week intervals

Question 24

what does roflumilast do?

Answer 24

decrease exacerbations when added on

Question 25

when would we use azithromycin for COPD?

Answer 25

smokers with exacerbations

Question 26

T/F can only use a spacer with HFA type inhalers

Answer 26

true