Exam 3 COPD Flashcards
Describe COPD briefly
A lung disease caused by exposure to noxious particles or gases that is progressive and persistent. It is a combination of both small airway disease and parenchymal destruction.
Name the three components of COPD
Emphysema, chronic bronchitis, and inflammation
What is the name for the abnormal enlargement of lung airspaces accompanied by alveolar wall destruction?
Emphysema
Chronic bronchitis is defined as the presence of cough and sputum production for at least __ months in each of __ consecutive years
At least 3 months; 2 consecutive years
Which COPD component can also be an independent disease?
Chronic bronchitis
What is the primary cause of chronic bronchitis in COPD patients?
Airway narrowing due to fibrosis, smooth muscle hyperplasia, inflammation, etc.
What are the two ways that noxious gases harm the lungs?
Oxidative stress and protease-antiprotease imbalance
What is a major inflammatory cell involved in COPD?
CD8 (cytotoxic) T cells
What signs and symptoms can help you diagnose COPD?
Hypoxemia, hypercapnia, cyanotic membranes, barrel chest, rapid breathing, pursed lips when breathing, use of accessory muscles to breath, thick neck, mucous hypersecretion, decreased FEV1 and FEV1/FVC, pulmonary HTN if you go invasive
Answer the following with either asthma or COPD:
Which pathophysiology involves eosinophils?
Which pathophysiology involves CD8 T cells?
Which responds better to corticosteroids?
Which involves IL-4, IL-5, and LTD4 in the disease process?
Which pathophysiology involves neutrophils?
Eosinophils -- asthma CD8 T cells -- COPD Corticosteroids -- asthma IL-4, IL-5, LTD4 -- asthma Neutrophils -- COPD
What is the number one modifiable risk factor for COPD and the only one that can be reversed or at least slowed?
Smoking
What are the other modifiable risk factors for COPD (besides smoking)?
Occupational dust and chemicals, air pollution
What risk factors for COPD are unchangeable?
Genetic predisposition – esp a1 - antitrypsin recessive deficiency in antiprotease – airway hyperresponsiveness, and impaired lung growth (low birth weight, infections)
What are the three hallmark symptoms of COPD?
Chronic cough, SOB, and sputum production
What lab diagnostic is required to make a COPD diagnosis?
Spirometry – post-bronchodilator FEV1/FVC <0.7
What four aspects of COPD must all be considered separately when treating?
Symptoms, spirometry, exacerbation risk, and comorbidities
What symptom assessment measured just breathlessness?
mMRC – 2 or higher is more severe interference with ADL
What COPD symptom assessment is more comprehensive?
CAT – COPD assessment test. 10 or higher is more severe interference with ADL
For GOLD classifications based on post-bronchodilator FEV1/FVC, what are the three divisions?
80%, 50%, and 30%. An 80% or higher is score one (good) whereas lower than a 30% is a four (bad)
List some possible COPD comorbitidities
Cardiovascular disease, skeletal muscle dysfunction, metabolic syndrome, osteoporosis, depression, lung cancer. These can influence mortality/hospitalizations.
If a COPD patient had a CAT score of 10, a mMRC score of 1, a GOLD score of 2, and one non-hospitalized exacerbation in the last year, what group would the patient be in?
Group B (low risk, more symptoms)
If a COPD patient had a CAT score of 8, a GOLD score of 2, and one hospitalized exacerbation in the last year, what group would the patient be in?
Group C (high risk, less symptoms)
What three non-pharmacologic treatments are especially important for COPD?
Smoking cessation, influenza/pneumococcal vaccination, and physical activity, possibly pulmonary rehabilitation
What pharmacological treatment is recommended for GOLD patient group A?
SABA or SA anticholinergic (albuterol or ipratropium – usually albuterol)
What pharmacological treatment is recommended for GOLD patient group B?
LABA or LA anticholinergic – Salmeterol/formoterol or Spiriva (tiotropium). Spiriva usually preferred b/c once a day dosing, better side effect profile.
(also with rescue inhaler)
What pharmacological treatment is recommended for GOLD patient group C?
Any 2 of ICS, LABA, or LA anticholinergic. Advair is option if want to do one inhaler.
(also with rescue inhaler)
What pharmacological treatment is recommended for GOLD patient group D?
ICS + LABA + LA anticholinergic
also rescue inhaler
True or false: Adequate pharmacologic therapy for a COPD patient can slow disease progression.
False – clinical trials showed no change
What are the only two once-a-day LABAs?
Indacaterol (Arcapta, Neohaler) DPI and olodaterol (Striverdi, Respimat) MDI – both $$
What are the two long-acting anticholinergics?
Tiotropium (Spiriva Handihaler) once daily and Aclidinium (Turdoza Pressair) BID
What are the brand names for the albuterol rescue inhalers?
Proair, Proventil, Ventolin
What is the brand name for salmeterol?
Serevent Diskus – DPI BID
In which disease is it more common to use the methylxanthine theophylline?
COPD – throwing the kitchen sink at these patients
Which drug class should not be used as monotherapy in asthma? COPD?
Asthma – don’t use LABAs alone
COPD – don’t use corticosteroids alone
What drug is notorious for causing atrial and ventricular arrhythmias, grand mal convulsions, insomnia, nausea, heartburn, and headaches?
Theophylline (Theo-24 or Theochron)
What drug is the only LABA + LA anticholinergic combination?
Vilanterol/umeclidinium (Anoro Ellipta) DPI once a day
What is the brand name for the albuterol/ipratropium DPI?
Combivent – QID if scheduled instead of prn
What is the only once daily LABA + ICS combination?
Vilanterol/fluticasone (Breo Ellipta) DPI
What is the PDE-4 inhibitor that we can give to COPD patients?
Roflumilast (Daliresp) – once daily 500mcg oral tablet
Inhibits cAMP breakdown
Significant ADE including reduced appetite, sleep disturbances
What drug class is often given in COPD exacerbations but almost never given for asthma?
Antibiotics
What non-pharmacological therapies may have to be considered for severe COPD?
Pulmonary rehabilitation, oxygen therapy, surgery (bullectomy, volume reduction, transplant)
How do you diagnose a COPD exacerbation?
Based on clinical presentation and variation from normal day to day function
What drugs are given during a COPD exacerbation?
Short-acting bronchodilators (SABA preferred with or w/o SA anticholinergics), systemic corticosteroids (40mg PO daily x 5 days), antibiotics (if 3 cardinal symptoms or increased sputum thickness plus either increased SOB or increased sputum volume) 5-10 days
What non-pharmacologic therapy can be given in a COPD exacerbation?
Oxygen therapy or ventilator support
When should you discharge a COPD patient after an exacerbation?
After they have been clinically stable for 12-24 hours, are able to function almost normally, don’t need SABA <q4h
