COPD Flashcards
Definition : Chronic respiratory sx’s such as ?
Due to abnormalities of the airways such as ? and or alveoli such as ?
That cause __.__.___
Can lead to __ and __
dyspnea, cough, sputum production and/or exacerbations
bronchitis, bronchiolitis ,emphysema
persistent, often progressive, airflow
obstruction.
scarring , fibrosis
Sx’s of COPD (6)
-Pt’s may experience ___ characterized by ____ (exacerbations)
-Pt’s often have other __
dyspnea (SOB), cough with or without sputum, chest tightness/wheezing, fatigue, activity limitations, weight loss
acute respiratory events, worsening of sx’s
comorbid diseases
COPD Vs Asthma
COPD : Talk about sx progression and risk factors
Asthma : Talk about sx’s and other factors that differ from COPD
COPD : sx’s slowly progressive , history of tobacco smoking or other risk factors
ASTHMA : Variable airlflow obstruction
sx’x vary widely from day to day, sx’s worse at night or early morning, allergy, rhinitis, and or eczema also present, often occurs in children, family history of asthma
Role of Spirometry in COPD :
What values of spirometry do you use to diagnose someone with COPD?
Post-Bronchodilator FEV1/FVC <0.7
GOLD Grades In COPD pt’s (FEV1/FVC < 0.7)
GOLD 1
GOLD 2
GOLD 3
GOLD 4
1 : Mild, FEV1 >/= 80% predicted
2: Mod, FEV1 >/= 50% but less than 80% predicted
3: Severe FEV1 >/= 30% and less than 50% predicted
4: Very Severe FEV1<30% predicted
Goals of TX of stable COPD?
Things to reduce sx’s? (3)
Reducing risk? (3)
Relieve sx’s, improve exercise tolerance, improve health status
Prevent disease progression, prevent and treat exacerbations, reduce mortality
GOLD ABE Assessment Tool
Category A : Describe CAT, mMRC, and exacerbation requirements
Category B : CAT, mMRC, and Exacerbations
Category E : exacerbation history
Exacerbations = exacerbations per yr
A : CAT <10, mMRC 0-1, exacerbations 0 or 1 moderate exacerbations not leading to hospitalization
B : CAT >/= 10, mMRC >/= 2, , exacerbations 0 or 1 moderate exacerbations not leading to hospitalization
E : >/= 2 moderate exacerbations or >/= 1 leading to hospitalization
For each group, state which is the preferred drug ?
Group A, B, E
What should be prescribed to ALL patients?
A: bronchodilator (LABA or LAMA preferred)
B : LABA + LAMA
E: LABA + LAMA, consider LABA + LAMA +ICS if blood eosinophils >/= 300
SABA or SAMA for immediate sx relief
What if the patient has asthma AND copd?
Follow asthma guidelines for pharmacotherapy
LABA :
AE’s (3)
Name 4
Tremor, tachycardia, hypokalemia
Salmeterol (serevent diskus dpi)
Olodaterol (Striverdi SMI)
Formoterol (Performomist)
Arformoterol (Brovana)
LAMA’s
-They have greater effect on ___ compared to LABA’s and decreased __
Warning : Use caution in which set of pt’s?
AE’s : (4)
Name 4
exacerbation reduction , hospitalization
narrow-angle glaucoma, myasthenia gravis, urinary retention or BPH
dry mouth, cough, bitter taste, urinary retention
Tiotropium (Spiriva Handihaler DPI, Spiriva respimat SMI)
Umeclidinium (Incruse Ellipta DPI)
Aclidinium (Tudorza Pressair DPI)
Revefenacin (Yupelri)
LABA/LAMA COmbos
Medication names of 4 !
Tiotropium/olodaterol (Stiolto 2.5/2.5 mcg)
Umeclidinium/vilanterol (Anoro Ellipta 62.5/25 mcg)
Glycopyrrolate/formoterol (Bevespri 9/4.8 mcg)
Aclidinium/formoterol (Duaklir Pressair 400/12 mcg)
LABA/LAMA/ICS COMBO
-Used for which group , and when ?
GOLD recs what?
Name 2
Group E if blood eosinophils >300 !
Use single combo inhaler if possible
Fluticasone/Umeclidinium/ Vilanterol (Trelegy , DPI)
Budesonide/glycopyrolate/formoterol (Breztri, MDI)
ICS for COPD is controversal… why?
Never use ICS as ___ for COPD pt’s
Include ICS If pt has both ??
Increased risk for pneumonia
monotherapy
Asthma + COPD
Follow up Pharm Tx :
What’s the flow for tx of exacerbations in COPD? For example, start at step 1 where pt is taking LABA or LAMA
A) Blood eso <300
B) Blood eos >300
C) AT LABA + LAMA usage but now blood eos <100 and have exacerbation
D) AT LABA + LAMA usage but now blood eos >100
E) Now at LABA + LAMA + ICS and an exacerbation occurs.. which two agents can u use?
A. LABA +LAMA
B. LABA + LAMA + ICS
C. Roflumilast (FEV1<50% and chronic bronchitis) or azithro (former smokers)
D. LABA LAMA and ICS
E) Roflumilast (FEV1<50% and chronic bronchitis) or azithro (former smokers)
