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COPD Treatment Flashcards

1
Q

When do you continue long-acting bronchodilators

A

-when patients are stable and can tolerate inhalers
-helps transition off short acting inhalers

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2
Q

What is the goal O2 saturation for acute COPD treatment?

A

88-92%

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3
Q

What are the benefits of systemic corticosertoids in acute COPD exacerbations?

A

-improved FEV1
-improve oxygenation
-shorten recovery time
-shorten hospitalization duration

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4
Q

What is the duration of systemic corticosteroid use in acute COPD exacerbations?

A

5 days

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5
Q

What is the agent and dose of systemic corticosteroid use in MILD acute COPD exacerbation?

A

Prednisone 40 mg PO

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6
Q

What is the agent and dose of systemic corticosteroid use in MODERATE acute COPD exacerbation?

A

Prednisone 40 mg PO

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7
Q

What is the agent and dose of systemic corticosteroid use in SEVERE acute COPD exacerbation?

A

Methylprednisolone 40-60 mg QD IV

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8
Q

What are some ADR of systemic corticosteroids?

A

-hyperglycemia
-leukocytosis
-infection
-fluid retention

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9
Q

What are the cardinal symptoms indicating antibiotic treatment in COPD?

A

-increased sputum purulence (REQUIRED)
+
-increased dyspnea OR increased sputum volume

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10
Q

What antibiotics do you use in COPD patient with uncomplicated and few exacerbations and no comorbidities?

A

-macrolide (azithromycin)
-2nd or 3rd Gen Cephalosporin
-doxycycline

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11
Q

What antibiotics do you use in COPD patient with complicated exacerbations, older age (>65), more than 4 exacerbations per year, or with comorbidities?

A

-augmentin
-respiratory FQ (levo or moxi)

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12
Q

What antibiotics do you use for COPD patients at high risk for multi-drug resistant pathogens?

A

-levofloxacin
-Cefepime or Ceftazidime

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13
Q

What puts a patient at high risk for multi-drug resistant pathogens?

A

-chronic corticostroid tx
-recent hospitalization <90 days
-recent antibiotix therapy <90 days

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14
Q

What is the duration of antibiotic tx for patients at high risk for multi-drug resistant pathogens?

A

5-7 days

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15
Q

What ADR do macrolides have?

A

-QTc prolongation
-ototoxicity

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16
Q

What are some ADR of cephalosporins?

A

-calcium ppt
-hemolytic anemia

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17
Q

What are some ADR of tetracyclines?

A

-possible bone growth suppression
-photosensitivity

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18
Q

What are some ADR of FQs?

A

-hepatotoxicity
-QTc prolongation
-dysglycemia
-cognitive side effects in older adults
-tendon rupture

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19
Q

What antibiotics should NEVER be recommended in acute COPD exacerbation?

A

-erythromycin due to insufficient coverage
-Bactrim
-amoxicillin
-first gen cephalosporins

20
Q

What comorbidities are COPD patients at increased risk for?

A

-CV disease (HF)
-osteoporosis
-respiratory infections
-anxiety/depression
-diabetes
-lung cancer
-bronchiectasis

21
Q

What initial treatment do we give Group E COPD patients?

A

LABA + LAMA (with short acting)

22
Q

What initial treatment do we give Group A COPD patients?

A

LABA OR LABA (with short acting)

23
Q

What initial treatment do we give Group B COPD patients?

A

LABA + LAMA (with short acting)

24
Q

When is ICS therapy indicated in COPD patients?

A

-concomitant asthma
-Eosinophil ≥300 (w/o exacerbations) or >100 (w/ exacerbations)
-history of hospitalizations for exacerbations
-≥ 2 moderate exacerbations per year

25
When is ICS therapy advised AGAINST in COPD patients?
-repeated pneumonia -eosinphils <100 -hx of myobacterial infections
26
When is ensifentrine used in the COPD treatment pathway?
during follow-up if the patient experiences persistent dyspnea and is already on LAMA+LABA
27
When is dupilumab used in COPD treatment pathway?
if the patient is already on LABA+LAMA+ICS and has exacerbation and/or dyspnea
28
When is roflumilast used in COPD treatment pathway?
in patients with exacerbations and/or dyspnea with FEV1 <50% and chronic bronchitis after already being on LABA+LAMA or LABA/LAMA/ICS
29
When is azithromycin used in chronic COPD treatment pathway?
in former smokers with exacerbations and/or dyspnea who are already on LABA/LAMA or LABA/LAMA/ICS
30
When do you consider switching patients on LABA/ICS to LABA/LAMA?
-no relevant exacerbation history OR -current exacerbations with eosinophil <100
31
When do you continue LABA/ICS treatment for patients currently on it?
-no current exacerbations -previous previous tx response -low symptom load
32
When do you switch patients on LABA/ICS to LABA/LAMA/ICS?
-no current exacerbations+previous tx response+high symptom load OR -current exacerbations + eosinophil >100
33
Which vaccines are recommended for COPD patients?
-Flu -COVID -Pneumococcal -RSV -TDAP -Zoster (if >50)
34
What is the minimum duration of pulmonary rehabilitation?
6 weeks
35
When is noninvasive ventilation (NIV) used?
-for those with severe COPD (marked hypercapnia) OR -COPD + sleep apnea
36
When is chronic O2 therapy beneficial?
-PaO2 <55 OR -O2<88 OR -PaO2 55-60 with right sided HF or erythrocytosis
37
What is the O2 saturation goal for chronic O2 therapy?
≥90
38
When do you reassess patient's need for O2 treatment in chronic COPD after initiation?
60-90 days
39
When can lung volume reduction surgery be beneficial?
-in patients with severe emphysema
40
How often do you do spirometry testing?
annually
41
How often do you do CAT or mMRC?
at each visit
42
How often do you check smoking status, medication ADR, and adherence?
at each visit
43
How long do you use corticosteroids in acute COPD patients with mild or moderate exacerbations?
5 days
44
What is the preferred alternative antibiotic to avoid QT prolongation?
Tetracyclines
45

IPC Pulmonology (7 decks)

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