Pulmonary Flashcards
What is the GOLD mild/moderate/severe/very severe classification/GRADING of COPD based on?
FEV1 scoring on PFTs; Grade 1-4
What is the GOLD ABCD tool based on?
Based on symptoms (A vs B) on x-axis and based on exacerbations on y-axis (C vs D). So if mild symptoms and few exacerbations, A, but if mild symptoms but more exacerbations C. If severe symptoms but few exacerbations, than B; if severe symptoms but more exacerbations, then D.
What is the first step after short-acting inhalers for COPD?
LAMA or LAMA/LABA
Tiotropium (Spiriva): Taken once daily using Respimat or Handihaler
Umeclidinium (Incruse)
What is the next best option after LAMA or LAMA/LABA and symptoms persist with COPD patient?
LAMA/LABA/ICS - Trelegy Ellipta
What are other options beyond inhalers for COPD?
rofilumast (if eos < 100), chronic azithromycin, pulmonary rehab
What are the 3 cardinal symptoms for COPD?
more dypsnea, increased sputum volume, or sputum purulence
For patients without PsA risk in COPD exacerbation while hospitalized, what abx should be used?
For most inpatients without risk factors for Pseudomonas infection, we select either a respiratory fluoroquinolone (ie, levofloxacin 500 mg orally or intravenously [IV] once daily or moxifloxacin 400 mg orally or IV once daily) or a third-generation cephalosporin (eg, ceftriaxone or cefotaxime).
For OUTpatients without PsA risk in COPD exacerbation, what abx should be used?
a macrolide (ie, azithromycin, clarithromycin) or a second- or third-generation cephalosporin (eg, cefuroxime, cefpodoxime, cefdinir).
Who should get abx in COPD exacerbations?
Moderate to severe COPD exac with increased in 3 cardinal symptoms (dyspnea, sputum purulence, sputum amount)
For OUTpatients with risk factors for poor outcomes (increased co-morbidities, exacerbations), what is best abx for COPD?
For outpatients who have risk factors for poor outcomes (but no increased risk for Pseudomonas infection), we broaden the initial regimen to include treatment for macrolide-resistant S. pneumoniae and to enhance eradication of H. influenzae. For these patients, we select either amoxicillin-clavulanate or a respiratory fluoroquinolone (ie, levofloxacin or moxifloxacin).
What are risk factors for PsA infection in COPD patients? (5 factors)
Chronic colonization or previous isolation of Pseudomonas aeruginosa from sputum (particularly in the past 12 months);
Very severe COPD (FEV1 <30% predicted)
Bronchiectasis on chest imaging;
Broad-spectrum antibiotic use within the past 3 months;
Chronic systemic glucocorticoid use
What are risk factors for poor outcomes in COPD exac patients? (6 factors)
Comorbid conditions (especially heart failure or ischemic heart disease);
Severe underlying COPD (eg, FEV1 <50%);
Frequent exacerbations of COPD (ie, ≥2 exacerbations per year);
Hospitalization for an exacerbation within the past 3 months;
Receipt of continuous supplemental oxygen
Age ≥65 years*
For OUTpatients with COPD exacerbation and risk factors for PsA, which abx?
Cipro - For outpatients who have risk factors for poor outcomes and a risk for Pseudomonas infection (table 3), we generally treat with ciprofloxacin.
What is the duration of abx treatment in COPD exac patients? Outpatient vs inpatient?
The duration of therapy for patients who are clinically improving is generally three to five days for outpatients and five to seven days for hospitalized patients.
When should you screen for lung cancer?
adults aged 50 to 80 years who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years.
How should you screen for lung cancer?
annual low dose chest CT
When should screening for lung cancer be discontinued?
Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery.
What are the main symptoms of COPD exacerbation that require antibiotics?
1) Increased sputum volume
2) Increased sputum purulence
3) Worsening dyspnea
Do biomarkers help with antibiotics in COPD exacerbation?
Not really – CRP might help reduce abx use (if greater than 40 and additional piece of data in grey area), but no diff in outcomes; procal use actually trend towards more hospitalization rate
