COPD Treatment

Question 1

GOLD and how do they grade

Answer 1

they produce the standards of care for COPD

• the assessment of COPD stages assigns a grade (A,b,c,d) to guide initial COPD managementt
• creates a graded approach to COPD managment
• all of the drugs when studied across a wide range of patients at different severities

Question 2

Assess exacerbation risk :

0-1 exacerbations without hospitalization

Answer 2

mmRc 0 to 1: act <10 = A

mMRC>2 ; CAT > 10: B

Question 3

> 2 exacerbations or >1 hospitalization

Answer 3

mmRc 0 to 1; cat <10 : C

mmRC >2; CAT > 10: D

Question 4

General measures for COPD treatment

Answer 4

1) smoking cessation
2) proper inhaler technique review
3) pulmonary rehabilitation and regular physical activity
4) vaccinations- influenza, pneumococcal, COVID
5) nutritioinio

Question 5

Group A definition

Answer 5

minimally symptomatic and low risk of excerbations

Question 6

Group A suggested treatment

Answer 6

Short acting bronchodilators- typically PRN

1) SABA - albuterol
2) SAMA - Ipratropium
3) SABA/SAMA - albuterol/ipratropium

Question 7

Bronchodilators affect on group 1

Answer 7

they have been shown to improve sxs, exercise capacity, and airflow limitations
- note: some new evidence showing use of LAMA - better than the placebo, but still investigating long-term outcomes before expanding roles of LAMAs in these patients

Question 8

Group B definition

Answer 8

Moderate to severely symptomatic with a low risk of exacerbations

Question 9

Treatment of Group B

Answer 9

• Chronic, regular treatment with a long-acting bronchodilator
  1) Most Common: LAMA
• LAMAS may have a slightly greater effect at preventing exacerbations
  2) Less Common: LABA monotherapy
  3) For severe breathlessness (CAT ≥ 20) – may initiate LAMA+LABA combination

Question 10

Group B ADRS

Answer 10

• Efficacy and safety are in general comparable across all LABAs and LAMAs – often decided on based on ADRs
  1) LABAs – resting tachycardia, tremor
  2) LAMAs – dry mouth, urinary retention

Question 11

SYMPTOMATIC RELIEF GROUP B

Answer 11

include a short-acting bronchodilator for acute symptomatic relief (usually a SABA)

Question 12

GROUP C DEFINITION

Answer 12

Mild or infrequent symptoms but high risk of exacerbation

Question 13

GROUP C USE

Answer 13

1) Regular, chronic treatment with a LAMA
- Showed reduced exacerbation rates in this group – However, no statistically significant reduction in overall hospitalizations or mortality
- Another study showed that tiotropium versus salmeterol increased the time to the first exacerbation
- Another study tiotropium showed better protection against exacerbations over the next year when compared to indacterol

Question 14

GROUP C ACUTE SYMPTOMATIC RELIEF

Answer 14

SABA

Question 15

GROUP D DEFINITION

Answer 15

Moderate to severe symptoms and high risk of exacerbations

Question 16

GROUP D USE

Answer 16

• Regular chronic treatment with a long-acting bronchodilator
  Initial therapy with LAMA
• For severe breathlessness (CAT ≥ 20) – may initiate LAMA+LABA combination
• Systematic review and meta-analysis of 10 trials– better quality of life, small increase in FEV1, reduced exacerbations

Question 17

GROUP D ACUTE SYMPTOMATIC RELIEF

Answer 17

SABA

Question 18

GOLD STRATEGY FOR GROUP D

Answer 18

• GOLD strategy suggests adding ICS in patients with frequent COPD exacerbations (≥2/year) and/or blood eosinophils ≥ 300 cells/microL
• Evaluate after 1-3 months for worsening symptoms, exacerbations, or failure of lung function to improve

Question 19

SABA EXAMPLES

Answer 19

Albuterol (Ventolin, Proair, Proventil), levalbuterol

Question 20

SAMA EXAMPLES

Answer 20

Ipratropium (Atrovent)

Question 21

LAMA EXAMPLES

Answer 21

tiotropium, aclidinium, umeclidinium, revefenacin, glycopyrrol

Question 22

LABA EXAMPLES

Answer 22

formoterol, olodaterol, salmeterol, arformoteroL

Question 23

ADVERSE AFFECTS OF GROUP B LABA AND LAMAS

Answer 23

LABAs – resting tachycardia, tremor

LAMAs – dry mouth, urinary retention