LECTURES 29 & 30 - COPD Flashcards
List factors that increase the risk of COPD exacerbation
- Smoking (or secondhand smoke)
- Respiratory infections (viral / bacterial)
- Exposure to air pollution / environmental irritants
- Low lung function (low FEV1) → < 80%
- Comorbidities (heart disease, diabetes), old age
What initial pharmacological treatment should be recommended for a patient with >/= 2 moderate exacerbations?
LABA + LAMA
What blood eos level would indicate the possible need for an ICS being added to a initial LABA + LAMA treatment?
> /= 300
If a patient with >/= 2 moderate exacerbations and no previous treatment has a blood eos level of < 300, should an ICS be added? Why?
No, an ICS should only be considered if blood eos >/= 300
What initial pharmacological treatment should be recommended for a patient with >/= 1 exacerbation(s) that led to hospitalization?
LABA + LAMA
If a patient with >/= 1 exacerbation(s) that led to hospitalization and no previous treatment has a blood eos level of 300, should an ICS be added? Why?
Yes, you should consider adding an ICS if the blood eos >/= 300
What initial pharmacological treatment should be recommended for a patient with:
- 1 exacerbation that did not lead to hospitalization
- mMRC = 0
- CAT = 9
A bronchodilator
because:
mMRC = 0-1
CAT < 10
What initial pharmacological treatment should be recommended for a patient with:
- NO exacerbations
- mMRC = 0
- CAT = 9
A bronchodilator
because:
mMRC = 0-1
CAT < 10
What initial pharmacological treatment should be recommended for a patient with:
- NO exacerbations
- mMRC = 3
- CAT = 11
LABA + LAMA
because:
mMRC >/= 2
CAT >/= 10
What initial pharmacological treatment should be recommended for a patient with:
- 1 exacerbation that did not lead to hospitalization
- mMRC = 3
- CAT = 11
LABA + LAMA
because:
mMRC >/= 2
CAT >/= 10
If a patient has 0-1 moderate exacerbations that do not lead to hospitalization, what treatment(s) could be suggested?
A bronchodilator
LABA + LAMA
What factors determine the preferred suggested treatment with 0-1 exacerbations that did not lead to hospitalization?
mMRC 0-1 OR >/=2
CAT < 10 OR >/= 10
List the potential treatments for a patient with 0-1 moderate exacerbations
A bronchodilator - (mMRC 0-1, CAT <10)
LABA + LAMA - (mMRC >/= 2, CAT >/= 10)
List the brand names of LABAs
Brovana
Perforomist
Striverdi
Serevent
List the generic names of LABAs
arformoterol
formoterol
olodaterol
salmeterol
List the brand/generic names of LABAs
Brovana - arformoterol
Perforomist - formoterol
Striverdi - olodaterol
Serevent - salmeterol
What is Perforomist / formoterol available as?
nebulizer
What is Brovana / arformoterol available as?
nebulizer
What is Striverdi / olodaterol available as?
Respimat
What is Serevent / salmeterol available as?
Diskus
List the brand names of LAMAs
Spiriva
Incruse
List the generic names of LAMAs
tiotropium
umeclidinium
List the brand/generic names of LAMAs
Spiriva - tiotropium
Incruse - umeclidinium
What is Spiriva / tiotropium available as?
Respimat (2.5 mcg)
Handihaler
What is Incruse / umeclidinium available as?
Ellipta
List the brand names of LABA + LAMAs
Stiolto
Anoro
List the generic names of LABA + LAMAs
tiotropium / olodaterol
Umeclidinium / vilanterol
List the brand/generic names of LABA + LAMAs
Stiolto - tiotropium / olodaterol
Anoro - umeclidinium / vilanterol
What is Stiolto (tiotropium / olodaterol) available as?
Respimat
What is Anoro (umeclidinium / vilanterol) available as?
Ellipta
List factors that “strongly favor use” of ICS treatment with long-acting bronchodilators
- History of hospitalization(s) for exacerbations of COPD
- > /= 2 moderate exacerbations of COPD per year
- Blood eosinophils >/= 300 cells/mcL
- History of, or concomitant asthma
List factors that “favor use” of ICS treatment with long-acting bronchodilators
- 1 moderate exacerbation of COPD per year
- Blood eosinophils 100 to 300 cells/mcL
List factors that indicate “against use” of ICS treatment with long-acting bronchodilators
- Repeated pneumonia events
- Blood eosinophils < 100 cells/mcL
- History of mycobacterial infection
If the patient is ALREADY being treated for COPD, and their treatment needs to be adjusted for an exacerbation, what needs to be considered to choose the best treatment?
blood eos levels (< 300 or >/= 300)
If the patient is ALREADY being treated for COPD, and their treatment needs to be adjusted for an exacerbation, what is the suggested treatment if their blood eos levels are < 300?
change from LABA / LAMA –> LABA + LAMA
If the patient is ALREADY being treated for COPD, and their treatment needs to be adjusted for an exacerbation, what is the suggested treatment if their blood eos levels are >/= 300?
LAMA / LABA -or- LAMA + LABA –> LABA + LABA + ICS
If the patient is ALREADY being treated for COPD (with LABA+LAMA), and their treatment needs to be adjusted for an exacerbation, what could be considered for treatment if their blood eos levels are < 100?
The patient could be considered for treatment with:
- Roflumilast (FEV1 < 50% & chronic bronchitis)
- Azithromycin (preferentially in former smokers)
If the patient is ALREADY being treated for COPD (with LABA+LAMA), and their treatment needs to be adjusted for an exacerbation, what could be considered for treatment if their blood eos levels are >/= 100?
an ICS should be added to their LABA + LAMA
(LABA + LAMA + ICS)
If the patient is ALREADY being treated for COPD (with LABA+LAMA+ICS), and their treatment needs to be adjusted for an exacerbation, what could be considered for treatment if their blood eos levels are >/= 300?
The patient could be considered for treatment with Dupilumab (chronic bronchitis)
If both dyspnea & exacerbation risk reduction is needed, which pathway should be utilized?
the exacerbation pathway
