Exam 3 COPD

Question 1

Describe COPD briefly

Answer 1

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.

Question 2

Name the three components of COPD

Answer 2

Emphysema, chronic bronchitis, and inflammation

Question 3

What is the name for the abnormal enlargement of lung airspaces accompanied by alveolar wall destruction?

Answer 3

Emphysema

Question 4

Chronic bronchitis is defined as the presence of cough and sputum production for at least __ months in each of __ consecutive years

Answer 4

At least 3 months; 2 consecutive years

Question 5

Which COPD component can also be an independent disease?

Answer 5

Chronic bronchitis

Question 6

What is the primary cause of chronic bronchitis in COPD patients?

Answer 6

Airway narrowing due to fibrosis, smooth muscle hyperplasia, inflammation, etc.

Question 7

What are the two ways that noxious gases harm the lungs?

Answer 7

Oxidative stress and protease-antiprotease imbalance

Question 8

What is a major inflammatory cell involved in COPD?

Answer 8

CD8 (cytotoxic) T cells

Question 9

What signs and symptoms can help you diagnose COPD?

Answer 9

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

Question 10

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?

Answer 10

Eosinophils -- asthma
CD8 T cells -- COPD
Corticosteroids -- asthma
IL-4, IL-5, LTD4 -- asthma
Neutrophils -- COPD

Question 11

What is the number one modifiable risk factor for COPD and the only one that can be reversed or at least slowed?

Answer 11

Smoking

Question 12

What are the other modifiable risk factors for COPD (besides smoking)?

Answer 12

Occupational dust and chemicals, air pollution

Question 13

What risk factors for COPD are unchangeable?

Answer 13

Genetic predisposition – esp a1 - antitrypsin recessive deficiency in antiprotease – airway hyperresponsiveness, and impaired lung growth (low birth weight, infections)

Question 14

What are the three hallmark symptoms of COPD?

Answer 14

Chronic cough, SOB, and sputum production

Question 15

What lab diagnostic is required to make a COPD diagnosis?

Answer 15

Spirometry – post-bronchodilator FEV1/FVC <0.7

Question 16

What four aspects of COPD must all be considered separately when treating?

Answer 16

Symptoms, spirometry, exacerbation risk, and comorbidities

Question 17

What symptom assessment measured just breathlessness?

Answer 17

mMRC – 2 or higher is more severe interference with ADL

Question 18

What COPD symptom assessment is more comprehensive?

Answer 18

CAT – COPD assessment test. 10 or higher is more severe interference with ADL

Question 19

For GOLD classifications based on post-bronchodilator FEV1/FVC, what are the three divisions?

Answer 19

80%, 50%, and 30%. An 80% or higher is score one (good) whereas lower than a 30% is a four (bad)

Question 20

List some possible COPD comorbitidities

Answer 20

Cardiovascular disease, skeletal muscle dysfunction, metabolic syndrome, osteoporosis, depression, lung cancer. These can influence mortality/hospitalizations.

Question 21

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?

Answer 21

Group B (low risk, more symptoms)

Question 22

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?

Answer 22

Group C (high risk, less symptoms)

Question 23

What three non-pharmacologic treatments are especially important for COPD?

Answer 23

Smoking cessation, influenza/pneumococcal vaccination, and physical activity, possibly pulmonary rehabilitation

Question 24

What pharmacological treatment is recommended for GOLD patient group A?

Answer 24

SABA or SA anticholinergic (albuterol or ipratropium – usually albuterol)

Question 25

What pharmacological treatment is recommended for GOLD patient group B?

Answer 25

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)

Question 26

What pharmacological treatment is recommended for GOLD patient group C?

Answer 26

Any 2 of ICS, LABA, or LA anticholinergic. Advair is option if want to do one inhaler.
(also with rescue inhaler)

Question 27

What pharmacological treatment is recommended for GOLD patient group D?

Answer 27

ICS + LABA + LA anticholinergic

also rescue inhaler

Question 28

True or false: Adequate pharmacologic therapy for a COPD patient can slow disease progression.

Answer 28

False – clinical trials showed no change

Question 29

What are the only two once-a-day LABAs?

Answer 29

Indacaterol (Arcapta, Neohaler) DPI and olodaterol (Striverdi, Respimat) MDI – both $$

Question 30

What are the two long-acting anticholinergics?

Answer 30

Tiotropium (Spiriva Handihaler) once daily and Aclidinium (Turdoza Pressair) BID

Question 31

What are the brand names for the albuterol rescue inhalers?

Answer 31

Proair, Proventil, Ventolin

Question 32

What is the brand name for salmeterol?

Answer 32

Serevent Diskus – DPI BID

Question 33

In which disease is it more common to use the methylxanthine theophylline?

Answer 33

COPD – throwing the kitchen sink at these patients

Question 34

Which drug class should not be used as monotherapy in asthma? COPD?

Answer 34

Asthma – don’t use LABAs alone

COPD – don’t use corticosteroids alone

Question 35

What drug is notorious for causing atrial and ventricular arrhythmias, grand mal convulsions, insomnia, nausea, heartburn, and headaches?

Answer 35

Theophylline (Theo-24 or Theochron)

Question 36

What drug is the only LABA + LA anticholinergic combination?

Answer 36

Vilanterol/umeclidinium (Anoro Ellipta) DPI once a day

Question 37

What is the brand name for the albuterol/ipratropium DPI?

Answer 37

Combivent – QID if scheduled instead of prn

Question 38

What is the only once daily LABA + ICS combination?

Answer 38

Vilanterol/fluticasone (Breo Ellipta) DPI

Question 39

What is the PDE-4 inhibitor that we can give to COPD patients?

Answer 39

Roflumilast (Daliresp) – once daily 500mcg oral tablet
Inhibits cAMP breakdown
Significant ADE including reduced appetite, sleep disturbances

Question 40

What drug class is often given in COPD exacerbations but almost never given for asthma?

Answer 40

Antibiotics

Question 41

What non-pharmacological therapies may have to be considered for severe COPD?

Answer 41

Pulmonary rehabilitation, oxygen therapy, surgery (bullectomy, volume reduction, transplant)

Question 42

How do you diagnose a COPD exacerbation?

Answer 42

Based on clinical presentation and variation from normal day to day function

Question 43

What drugs are given during a COPD exacerbation?

Answer 43

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

Question 44

What non-pharmacologic therapy can be given in a COPD exacerbation?

Answer 44

Oxygen therapy or ventilator support

Question 45

When should you discharge a COPD patient after an exacerbation?

Answer 45

After they have been clinically stable for 12-24 hours, are able to function almost normally, don’t need SABA <q4h