Exam 1 - Chronic Obstructive Pulmonary Disease (chronic) Flashcards
What are risk factors for COPD? (5)
cigarette smoke/occupation chemicals/pollution, genes (alpha-1 antitrypsin deficiency), severe childhood respiratory infections, SE status, age
What are symptoms of COPD? (3)
progressively worsening and persistent dyspnea, chronic coughing/wheezing, sputum
What FEV1/FVC ratio is required for a diagnosis of COPD?
< 0.7
What are the LABAs? (4)
salmeterol (Servent), formoterol (Perforomist), oladeterol (Striverdi Respimat), arformoterol (Brovana)
What are the SAMAs? (1)
ipatropium bromide (Atovent HFA)
What are the LAMAs? (5)
tiotropium (Spiriva), aclidinium (Tudorza), umeclidinium (Incruse), glycopyrrolate (Seebri, Lonhala), revefenacin (Yupelri)
What is the MOA of roflumilast (Daliresp)?
PDE4 inhibitor to increase cAMP
What are the AEs of roflumilast (Daliresp)? (4)
GI, weight loss, sleep disturbances, suicidal ideation
What are mild/moderate cutoffs for the mMRC and CAT assessments?
0-1 for mMRC, < 10 for CAT
How is a mild COPD exacerbation treated? Moderate? Severe?
mild = SABAs, moderate = SABAs + antibiotics and/or oral corticosteroids, severe = hospitalization
What is considered not high risk for COPD exacerbations? High risk?
not = 0 or 1 moderate exacerbation history (NO hospitalization), high = 2 or more exacerbations in last year or 1 or more exacerbations in the last year that led to hospitalization
What is treatment for Group A patients?
bronchodilator, PRN SABA/SAMA
What is treatment for Group B patients?
LABA + LAMA combination, PRN SABA/SAMA
What is treatment for Group E patients?
LABA + LAMA combination, PRN SABA/SAMA, ICS component if eos >/= 300
What is the follow-up treatment for patients experiencing dyspnea?
LABA or LAMA, then LABA + LAMA
What is the follow-up treatment for patients experiencing exacerbations?
LABA or LAMA, then LABA + LAMA if blood eos </= 300, add ICS if greater than 100 while on LABA + LAMA or if greater than 300 while on LABA or LAMA alone
What is the indication for roflumilast in COPD follow-ups with patients experiencing exacerbations?
FEV1 < 50% and chronic bronchitis
What is the indication for azithromycin in COPD follow-ups with patients experiencing exacerbations?
preferential in former smokers (NOT CURRENT SMOKERS)
When should ICS components be taken away from COPD patient regimens? (3)
repeated pneumonia events, history of mycobacterial infections, blood eos < 100
What does pulmonary rehabilitation entail? (3)
exercise training, nutritional counseling, smoking cessation and education
What does long-term oxygen therapy entail? (2)
long-term administration (>/= 15 hrs/day) of oxygen, goal of 90% or more
What is treatment for asthma-COPD overap?
ICS and consider LABA and/or LAMA
