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PHAR 253 > COPD > Flashcards

COPD Flashcards

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1
Q

define COPD

A

a respiratory disorder largely caused by smoking, and is characterized by progressive, partially reversible airway obstruction and lung hyperinflation, systemic manifestations, and increasing frequency and severity of exacerbations

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2
Q

emphysema

A

abnormal enlargement of the airspace distal to the terminal bronchioles, accompanied by destruction of their walls and without obvious fibrosis

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3
Q

chronic bronchitis

A

chronic cough for at least 3 months x 2 consecutive years

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4
Q

risk factors of COPD

A

exposure to particles
infections
socio-economic status
genetics
lung growth and development
airway hyper-responsiveness

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5
Q

what imbalance is noted in the lungs of patients with COPD?

A

protease-antiprotease

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6
Q

what may play an important role in amplifying the inflammatory process?

A

oxidative stress

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7
Q

what is a hallmark of COPD?

A

expiratory flow limitation due to increased resistance from mucosal inflammation, airway remodeling, fibrosis, and secretions

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8
Q

what causes lung hyperinflation?

A

obstruction of the small airways results in air-trapping

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9
Q

what do gas exchange abnormalities result in?

A

hypoxemia and hypercapnia

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10
Q

what is the result of mucous hypersecretion?

A

chronic productive cough

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11
Q

what happens during exacerbations?

A

there is an increase in hyperinflation and gas trapping, with decreased expiratory flow

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12
Q

what can lead to structural changes in late COPD?

A

pulmonary hypertension due to hypoxic vasoconstriction of small pulmonary arteries

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13
Q

what comorbidities are associated with COPD?

A

ischemic heart disease
congestive heart failure
arrhythmias
pulmonary hypertension
lung cancer
depression
metabolic disorders

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14
Q

what are the three cardinal symptoms of COPD?

A

shortness of breath
chronic cough
phlegm

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15
Q

end-stage symptoms of COPD

A

adopt positions that relieve dyspnea
use of accessory respiratory muscles
expiration through pursed lips
cyanosis
enlarged liver from right heart failure

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16
Q

how do patient initially present with COPD?

A

extremely sedentary lifestyle and presents with general fatigue
patient has complaints of dyspnea and chronic cough
episodes of cough, sputum, wheezing, fatigue and dyspnea

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17
Q

difference in age of onset in asthma vs. COPD

A

asthma usually < 40
COPD usually > 40

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18
Q

difference in smoking history in asthma vs. COPD

A

asthma - not causal, but worsens control
COPD - usually > 10 packs/year

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19
Q

difference in sputum production in asthma vs. COPD

A

asthma - infrequent
COPD - often

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20
Q

difference in allergies in asthma vs. COPD

A

asthma - often
COPD - infrequent

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21
Q

difference in clinical symptoms in asthma vs. COPD

A

asthma - intermittent and variable
COPD - persistent and progressive

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22
Q

difference in disease course in asthma vs. COPD

A

asthma - stable (with exacerbations)
COPD - progressive worsening (with exacerbations)

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23
Q

difference in spirometry in asthma vs. COPD

A

asthma - often normalizes
COPD - may improve but never normalizes

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24
Q

difference in airway inflammation in asthma vs. COPD

A

asthma - eosinophilic
COPD - neutrophilic

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25
difference in response to ICS in asthma vs. COPD
asthma - essential for optimal control COPD - helpful in patients with moderate to severe disease and frequent AECOPD
26
difference in role of bronchodilators in asthma vs. COPD
asthma - as needed use only COPD - regular therapy usually necessary
27
difference in role of exercise training in asthma vs. COPD
asthma - rarely formally used COPD - essential therapy
28
difference in end-of-life discussions in asthma vs. COPD
asthma - rarely necessary COPD - often essential
29
what is required to make a diagnosis of COPD?
spirometry - post bronchodilator FEV1/FVC ratio <0.7 confirms diagnosis
30
who should be screened for COPD?
patients with risk factors - smokers/ex-smokers >40 who have: - persistent cough or sputum production - frequent respiratory tract infections - progressive activity-related SOB - evening wheeze
31
what results would be seen in a pulmonary function test of someone with COPD?
FEV1 < 80% and FEV1/FVC ratio <0.7 OR FEV1/FVC less than the lower limit of normal (more accurate)
32
how are total pack years calculated?
(# of cigarettes smoked/day / 20) x # years of smoking
33
grade 0 on mMRC dyspnea scale
breathless with strenuous exercise (lots of people)
34
grade 1 on mMRC dyspnea scale
MILD stage - SOB when hurrying on the level or walking up a slight hill
35
grade 2 on mMRC dyspnea scale
MODERATE stage - walks slower than people of the same age on the level or stops for breath while walking at own pace on the same level
36
grade 3 on mMRC dyspnea scale
MODERATE stage - stops for breath after walking 100 meters or after a few minutes on the same level
37
grade 4 on mMRC dyspnea scale
SEVERE stage - too breathless to leave the house, or breathlessness when dressing
38
what is the CAT test?
validated, short and simple patient completed questionnaire
39
how does the scoring work for a CAT test?
score ranges from 0-40 - 0-10 = low impact - 11-20 = medium impact - 21-30 = high impact - >30 = very high impact
40
spirometry post bronchodilator for MILD COPD
FEV1 >80% of predicted FEV1/FVC < 0.7
41
spirometry post bronchodilator for MODERATE COPD
FEV1 50-79% of predicted FEV1/FVC < 0.7
42
spirometry post bronchodilator for SEVERE COPD
FEV1 30-49% of predicted FEV1/FVC < 0.7
43
spirometry post bronchodilator for VERY SEVERE COPD
FEV1 < 30% of predicted FEV1/FVC < 0.7
44
goals of therapy for COPD
prevent disease progression prevent and treat exacerbations alleviate breathlessness and other respiratory symptoms improve exercise tolerance and daily activities prevent and treat complications of the disease improve health status reduce mortality
45
treatment options for COPD
smoking cessation eliminate exposures patient education avoid sedatives / narcotics vaccines pharmacological treatment
46
what is the only intervention shown to slow progression of COPD?
smoking cessation
47
what are the benefits of pulmonary rehabilitation?
reduced dyspnea increased exercise endurance improved quality of life decreased fatigue
48
what vaccines are recommended for patients with COPD?
annual flu vaccine pneumococcal vaccine
49
what is the main pharmacologic treatment for COPD?
bronchodilators
50
dosing of SABAs in COPD
QID prn
51
what is the short acting muscarinic antagonist (SAMA) and its dosing?
ipratropium QID prn
52
what is the combo SABA & SAMA and its dosing?
salbutamol + ipratropium (Combivent) QID prn
53
MOA od SAMAs and LAMAs
competitively inhibit cholinergic receptors in bronchial smooth muscle
54
SAMA effectiveness
less effective then B2 agonists in asthma slower onset of action than SABAs
55
adverse effects of SAMA & LAMA
dry mouth cough constipation urinary retention headache
56
what is the dosing for the LABAs in COPD?
salmeterol and formoterol - BID indacaterol and olodaterol - OD
57
what are the LAMAs and their dosing?
tiotropium - OD aclindinium - BID glycopyrronium - OD umeclidinium - OD
58
what is the difference in LABAs and LAMAs?
both improve symptoms Tiotropium (LAMA) may be superior in decreasing exacerbations LAMAs may be better tolerated
59
should ICS be used in COPD?
should not be used as first line or as monotherapy they do have some evidence for reducing exacerbations though
60
what kind of combo products are there in COPD?
LAMA/LABA SAMA/SABA ICS/LABA LABA/LAMA/ICS
61
what is N-acetylcysteines role in COPD?
high dose, 600mg orally BID may reduce exacerbations in those who had 2 or more exacerbations in the previous 2 year period
62
what is roflumilast?
a phosphodiesterase IV inhibitor that improves FEV1 and can decrease exacerbations
63
what is the dosing for roflumilast?
500mcg tab OD added on to bronchodilator treatment
64
side effects of roflumilast
diarrhea weight loss nausea headache sleep disturbances
65
pros and cons of theophylline in COPD
pros - effective bronchodilator taken OD or BID cons - serious drug toxicity may occur, and several potential drug interactions
66
low risk of exacerbations
1 or less moderate exacerbation in the last year
67
high risk of exacerbations
2 moderate or 1 severe exacerbation in the last year requiring hospital admissions/ED visit
68
drug treatment of mild COPD
SABA prn and LAMA or LABA
69
drug treatment for moderate and severe COPD with low risk AECOPD
SABA prn + LAMA/LABA combo step up to LAMA/LABA/ICS if needed
70
drug treatment for moderate and severe COPD with high risk AECOPD
SABA prn + LAMA/LABA/ICS can add on prophylactic macrolide/PDE-4 inhibitor/mucolytic agents if needed
71
what are some other serious therapies for COPD?
lung volume reduction surgery lung transplantation
72
what is an acute exacerbation?
sustained worsening of dyspnea, cough or sputum production leading to an increase in the use of maintenance medications and/or supplementation with additional medications
73
what is the treatment of acute exacerbations?
bronchodilators - SAMA and SABA become scheduled steroids (systemic) - restore lung function quicker. typically dosed prednisone 30-50mg daily x 5-14 days antibiotics when sputum is yellow or green, increased sputum volume and increased dyspnea
74
which antibiotics could be used in COPD without risk factors?
amoxicillin doxycycline cotrimoxazole (x5-7 days)
75
which antibiotics could be used in COPD with risk factors?
amoxi clav (5-10 days) cefuroxime axetil (5-10 days) levofloxacin (3-5 days)

PHAR 253 (8 decks)

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