COPD 2: Treatment

Question 1

When following up on a patient’s COPD what are the two catgegories that must be assessed

Answer 1

Dyspnea and exacerbations

Question 2

What is the regimen change if a patient has a follow up for COPD and the dyspnea has gotten worse

Answer 2

Start using a LABA and LAMA

Question 3

What is the two regimen change options if a patient has a follow up for COPD and the exacerbations are worse

Answer 3

Start using a LABA and LAMA or start using a LABA and ICS

Question 4

When would a patient use a LABA and ICS regimen change option

Answer 4

If their eosinophils are greater than 300 or their eosionophils are greater than 100 AND 2 or more moderate exacerbation or 1 hospitalization

Question 5

What cell line usually causes the inflammation in COPD

Answer 5

Neutrophils

Question 6

What is the cell line that can cause inflammation in COPD but usually does not unless under certain circumstances, what are those circumstances

Answer 6

Eosinophils, exacerbatons and the patient has both ashtma and COPD

Question 7

Increased eosinophils are associated with what in COPD

Answer 7

increased risk of COPD exacerbations, reduced lung function

Question 8

T/F: Inhaled corticoidsteriods are more likely to cause pneumonia if used alone in COPD patients

Answer 8

True

Question 9

What are the combination ICS and LABA medications that are apporved for COPD

Answer 9

Symbicort (budenoside/Formoterol), Advair Diskus and Adbair HFA (fluticasone propionate/salmeterol), Breo Ellipta (fluticasone furoate/vilanterol)

Question 10

What are side effects of inhaled corticosteroids

Answer 10

thrush, osteoporosis, cataracts, pneumonia

Question 11

What are risk factors for a patient to get pneumonia from their ICS

Answer 11

prior pneumonia, current smoker, greater than 55 years old, overweight, FEV1 is between 30% and 50%, blood eosinophil is less than 2%

Question 12

What is the triple therapy that is approved for COPD

Answer 12

Fluticasone furoate and umeclidinium and Vilanterol

Question 13

What is the result of using phosphodiesterase 4

Answer 13

supression of action in neutrophils, macrophages, and CD8 T cells

Question 14

What is drug is a PDE4 inhibitor

Answer 14

roflumilast (Daliresp)

Question 15

When would PDE4 inhibitors be used in a patient

Answer 15

chronic cough and/or sputum production, 1 hospitalization in the past year, add-on therapy for FEV1 less than 50% predicted

Question 16

What are the side effects of PDE4 inhibitors

Answer 16

diarrhea, weight decrease, nausea

Question 17

T/F: CYP34A enzymes metabolize PDE4 inhibitors

Answer 17

True

Question 18

What macrolide would be added to a patient’s regimen for COPD, when

Answer 18

azithromycin, severe COPD with multiple exacerbations, adherent to bronchodilator and anti-inflammatory medication, not smoking tobacco