Respiratory: Chronic obstructive pulmonary disease

Question 1

Infection can complicate chronic obstructive pulmonary disease and may be prevented by vaccination. What vaccinations are recommended?

Answer 1

Pneumococcal vaccination and an annual influenza vaccination should be offered to all patients with COPD as recommended by the Chief Medical Officer.

Question 2

Symptoms of COPD may be alleviated by inhaled forms of what class of drugs prn?

Answer 2

Short-acting beta2-agonist OR a short-acting antimuscarinc bronchodilator

Question 3

If the FEV1 is 50% ,or more, of predicted in COPD, either a long-acting antimuscarinic bronchodilator or what should be used?

Answer 3

If the Forced Expiratory Volume in 1 second (FEV1), is 50% of predicted or more, either a long-acting antimuscarinic bronchodilator or a long-acting beta2 agonist should be used. Short-acting antimuscarinic bronchodilators should be discontinued when a long-acting antimuscarinic bronchodilator is started. A long-acting beta2 agonist with a corticosteroid in a combination inhaler can be used for patients who remain symptomatic despite regular treatment with a long-acting beta2 agonist.

Question 4

In COPD (FEV1 >50%), can a SABA be used with a LABA?

Answer 4

Yes, a SABA can be continued at all stages of COPD treatment.

Question 5

What can be used in patients who remain symptomatic despite regular treatment with a long-acting beta2 agonist in COPD (FEV >50%)?

Answer 5

A long-acting beta2 agonist with a corticosteroid in a combination inhaler can be used for patients who remain symptomatic despite regular treatment with a long-acting beta2 agonist.

Question 6

If in COPD the FEV1 <50%, what treatment should be tried?

Answer 6

Either a long-acting antimuscarinic bronchodilator or a long-acting beta2 agonist with a corticosteroid in a combination inhaler should be used.

Question 7

In any patient with COPD who remains breathless or continues to have exacerbations, triple therapy with what should be used?

Answer 7

In any patient who remains breathless or continues to have exacerbations, triple therapy with a long-acting beta2 agonist and a corticosteroid in a combination inhaler plus a long-acting antimuscarinic bronchodilator should be used.

Question 8

What is triple therapy?

Answer 8

LABA + ICS combo, + LAMA

Question 9

IF an inhaled corticosteroid is not appropriate, what can be used with a LABA?

Answer 9

LAMA

Question 10

If COPD symptoms persist despite triple therapy or if the patient is unable to use an inhaler, what should be used?

Answer 10

oral modified-release aminophylline or theophylline can be used.

Question 11

Indacaterol is what type of drug licensed for the maintenance treatment of COPD?

Answer 11

Indacaterol is a long-acting beta2 agonist licensed for the maintenance treatment of chronic obstructive pulmonary disease.

Onbrez Breezhaler

Question 12

In patients with severe chronic obstructive pulmonary disease associated with chronic bronchitis and a history of frequent exacerbations, what phosphodiesterase type-4 inhibitor with anti-inflammatory properties is licensed as an adjunct to existing bronchodilator treatment?

Answer 12

In patients with severe chronic obstructive pulmonary disease associated with chronic bronchitis and a history of frequent exacerbations, roflumilast is licensed as an adjunct to existing bronchodilator treatment.

Question 13

Carbocisteine is what type of drug used in COPD?

Answer 13

A mucolytic drug may be considered for a patient with a chronic productive cough.

Question 14

A Bricanyl inhaler is what type of therapy?

Answer 14

Terbutaline SABA therapy

Question 15

Atrovent inhaler is what type of therapy?

Answer 15

Antimuscarinic: ipratropium

Question 16

phosphodiesterase type-4 inhibitor with anti-inflammatory properties that is licensed as an adjunct to existing bronchodilator treatment in COPD

Answer 16

Roflumilast

Question 17

A Serevent inhaler is what type of therapy?

Answer 17

Serevent® - a green-coloured inhaler.

Salmeterol - LABA

Question 18

Onbrez Breezhaler is what type of therapy?

Answer 18

LABA - indacaterol.

Question 19

Seebri Breezhaler is what type of therapy?

Answer 19

Glycopyrronium - LAMA

Question 20

What is the active in Incruse Elipta? What type of therapy?

Answer 20

Umeclidinium - LAMA

Question 21

Tiotropium is a LAMA found in what brand of inhaler?

Answer 21

Spiriva

Question 22

Aclidinium is a LAMA found in what brand of inhaler?

Answer 22

Eeklira Genuair

Question 23

A fostair inhaler contains

Answer 23

Formeterol (LABA) + beclometasone

Question 24

Seretide inhaler contains

Answer 24

Salmeterol (LABA) + fluticasone.

Purple inhaler

Question 25

Symbicort inhaler contains

Answer 25

Formoterol (LABA) + budenoside

Question 26

Which of the following is the best additional therapy in a COPD patient with FEV >50% already on Salbutamol MDI:

Beclometasone (low dose dry powder inhaler)

Beclometasone (high dose metered dose inhaler)

Montelukast (oral)

Salmeterol (dry powder inhaler)

Tiotropium (metered dose inhaler)

Answer 26

Options for already on SABA and FEV>50% are:

LAMA or SAMA so narrows it down to salmeterol (dry powder inhaler) or tiotropium (metered dose inhaler).

As the patient is already on a MDI we would (could) choose the LAMA MDI option.