Study ?S Flashcards
Which ICS/LABA is NOT FDA approved for COPD?
Airduo (salemeterol 14mcg) and Dulera (mometasone/formoterol 5mcg)
COPD - The LABA or LAMA is not working what do you do?
LABA/LAMA
COPD - The LABA/ICS is not working, what do you do?
Triple therapy or increase the dose or switch to LABA/LAMA
COPD Exacerbation and on triple therapy - what do you do?
Add roflumilast if mucous bronchitis and FEV <50% - biologics - zmax for smokers
GOLD Guidelines Group A Tx
bronchodilator, short or long acting, long acting preferred unless seldom SOB
GOLD Guidelines Group B Tx
LABA or LAMA (LAMA better)
GOLD Guidelines Group E Tx
LABA/LAMA or Triple therapy if eosinophils >300
GOLD Guidelines Group A exacerbations, mMRC, and CAT scores
0 or 1 exacerbations, 0 hospitalizations, mMRC <2, CAT <10
GOLD Guidelines Group B exacerbations, mMRC, and CAT scores
0 or 1 exacerbations, 0 hospitalizations, mMRC>2 or CAT >10
GOLD Guidelines Group E exacerbations, mMRC, and CAT scores
> 2 exacerbations, mMRC and CAT are all irrelevant, treated the same
IL-4 Antagonist for asthma
Dupixent (Dupilumab)
IL-5 Antagonists for asthma
Benralizumab
Reslizumab
Mepolizumab
anti-TSLR for asthma
Tezepelumab (Tezspire)
Asthma Step 1 Tx
Symbicort PRN
Asthma Step 2 Tx
Symbicort PRN (could be scheduled)
Asthma Step 3 Tx
Low-dose Symbicort and PRN
Asthma Step 4 Tx
Med-dose Symbicort and PRN
Asthma Step 5 Tx
High Dose Symbicort
Triple Therapy
Immunologics
Only LAMA approved for asthma >12
Spiriva Respimat
Inhaler contraindicated in milk allergy
Fluticasone Arnuity Ellipta
Asthma Control Class… Frequency of Symptoms
Mild - <2 days/wk
Mild Persistent - 2-5 days/wk
Mod Persistent - >5 days but not daily
Severe Persistent - throughout the day
Asthma Control Class…
Nighttime Awakenings
Mild - <2/mo
Mild Persistent - 2-4 mo
Mod Persistent - >4/mo
Severe Persistent - nightly
Asthma Control Class…
Activity Interference
Mild - none
Mild Persistent - slight
Mod Persistent - some
Severe Persistent - a lot
Asthma Control Class…
OCS use
Mild - 0 or 1
Persistent - at least twice
Mild Asthma Tx
SMART - Symbicort PRN or SABA PRN based on age
Mild Persistent Asthma Tx
Symbicort PRN (could schedule)
SABA PRN, schedule ICS
Severe Persistent Asthma Tx
High Dose ICS-LABA
Triple Therapy
OCS
Moderate Persistent Asthma Tx
Symbicort low dose scheduled and PRN
ICS med dose and SABA PRN
Possible OCS