Exam 1 - Chronic Obstructive Pulmonary Disease (chronic)

Question 1

What are risk factors for COPD? (5)

Answer 1

cigarette smoke/occupation chemicals/pollution, genes (alpha-1 antitrypsin deficiency), severe childhood respiratory infections, SE status, age

Question 2

What are symptoms of COPD? (3)

Answer 2

progressively worsening and persistent dyspnea, chronic coughing/wheezing, sputum

Question 3

What FEV1/FVC ratio is required for a diagnosis of COPD?

Answer 3

< 0.7

Question 4

What are the LABAs? (4)

Answer 4

salmeterol (Servent), formoterol (Perforomist), oladeterol (Striverdi Respimat), arformoterol (Brovana)

Question 5

What are the SAMAs? (1)

Answer 5

ipatropium bromide (Atovent HFA)

Question 6

What are the LAMAs? (5)

Answer 6

tiotropium (Spiriva), aclidinium (Tudorza), umeclidinium (Incruse), glycopyrrolate (Seebri, Lonhala), revefenacin (Yupelri)

Question 7

What is the MOA of roflumilast (Daliresp)?

Answer 7

PDE4 inhibitor to increase cAMP

Question 8

What are the AEs of roflumilast (Daliresp)? (4)

Answer 8

GI, weight loss, sleep disturbances, suicidal ideation

Question 9

What are mild/moderate cutoffs for the mMRC and CAT assessments?

Answer 9

0-1 for mMRC, < 10 for CAT

Question 10

How is a mild COPD exacerbation treated? Moderate? Severe?

Answer 10

mild = SABAs, moderate = SABAs + antibiotics and/or oral corticosteroids, severe = hospitalization

Question 11

What is considered not high risk for COPD exacerbations? High risk?

Answer 11

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

Question 12

What is treatment for Group A patients?

Answer 12

bronchodilator, PRN SABA/SAMA

Question 13

What is treatment for Group B patients?

Answer 13

LABA + LAMA combination, PRN SABA/SAMA

Question 14

What is treatment for Group E patients?

Answer 14

LABA + LAMA combination, PRN SABA/SAMA, ICS component if eos >/= 300

Question 15

What is the follow-up treatment for patients experiencing dyspnea?

Answer 15

LABA or LAMA, then LABA + LAMA

Question 15

What is the follow-up treatment for patients experiencing exacerbations?

Answer 15

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

Question 16

What is the indication for roflumilast in COPD follow-ups with patients experiencing exacerbations?

Answer 16

FEV1 < 50% and chronic bronchitis

Question 17

What is the indication for azithromycin in COPD follow-ups with patients experiencing exacerbations?

Answer 17

preferential in former smokers (NOT CURRENT SMOKERS)

Question 18

When should ICS components be taken away from COPD patient regimens? (3)

Answer 18

repeated pneumonia events, history of mycobacterial infections, blood eos < 100

Question 19

What does pulmonary rehabilitation entail? (3)

Answer 19

exercise training, nutritional counseling, smoking cessation and education

Question 20

What does long-term oxygen therapy entail? (2)

Answer 20

long-term administration (>/= 15 hrs/day) of oxygen, goal of 90% or more

Question 21

What is treatment for asthma-COPD overap?

Answer 21

ICS and consider LABA and/or LAMA