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PHAR 253 > COPD > Flashcards

COPD Flashcards

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
Q

difference in response to ICS in asthma vs. COPD

A

asthma - essential for optimal control
COPD - helpful in patients with moderate to severe disease and frequent AECOPD

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26
Q

difference in role of bronchodilators in asthma vs. COPD

A

asthma - as needed use only
COPD - regular therapy usually necessary

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27
Q

difference in role of exercise training in asthma vs. COPD

A

asthma - rarely formally used
COPD - essential therapy

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28
Q

difference in end-of-life discussions in asthma vs. COPD

A

asthma - rarely necessary
COPD - often essential

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29
Q

what is required to make a diagnosis of COPD?

A

spirometry
- post bronchodilator FEV1/FVC ratio <0.7 confirms diagnosis

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30
Q

who should be screened for COPD?

A

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

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31
Q

what results would be seen in a pulmonary function test of someone with COPD?

A

FEV1 < 80% and FEV1/FVC ratio <0.7
OR FEV1/FVC less than the lower limit of normal (more accurate)

32
Q

how are total pack years calculated?

A

(# of cigarettes smoked/day / 20) x # years of smoking

33
Q

grade 0 on mMRC dyspnea scale

A

breathless with strenuous exercise (lots of people)

34
Q

grade 1 on mMRC dyspnea scale

A

MILD stage - SOB when hurrying on the level or walking up a slight hill

35
Q

grade 2 on mMRC dyspnea scale

A

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
Q

grade 3 on mMRC dyspnea scale

A

MODERATE stage - stops for breath after walking 100 meters or after a few minutes on the same level

37
Q

grade 4 on mMRC dyspnea scale

A

SEVERE stage - too breathless to leave the house, or breathlessness when dressing

38
Q

what is the CAT test?

A

validated, short and simple patient completed questionnaire

39
Q

how does the scoring work for a CAT test?

A

score ranges from 0-40
- 0-10 = low impact
- 11-20 = medium impact
- 21-30 = high impact
- >30 = very high impact

40
Q

spirometry post bronchodilator for MILD COPD

A

FEV1 >80% of predicted
FEV1/FVC < 0.7

41
Q

spirometry post bronchodilator for MODERATE COPD

A

FEV1 50-79% of predicted
FEV1/FVC < 0.7

42
Q

spirometry post bronchodilator for SEVERE COPD

A

FEV1 30-49% of predicted
FEV1/FVC < 0.7

43
Q

spirometry post bronchodilator for VERY SEVERE COPD

A

FEV1 < 30% of predicted
FEV1/FVC < 0.7

44
Q

goals of therapy for COPD

A

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
Q

treatment options for COPD

A

smoking cessation
eliminate exposures
patient education
avoid sedatives / narcotics
vaccines
pharmacological treatment

46
Q

what is the only intervention shown to slow progression of COPD?

A

smoking cessation

47
Q

what are the benefits of pulmonary rehabilitation?

A

reduced dyspnea
increased exercise endurance
improved quality of life
decreased fatigue

48
Q

what vaccines are recommended for patients with COPD?

A

annual flu vaccine
pneumococcal vaccine

49
Q

what is the main pharmacologic treatment for COPD?

A

bronchodilators

50
Q

dosing of SABAs in COPD

A

QID prn

51
Q

what is the short acting muscarinic antagonist (SAMA) and its dosing?

A

ipratropium QID prn

52
Q

what is the combo SABA & SAMA and its dosing?

A

salbutamol + ipratropium (Combivent) QID prn

53
Q

MOA od SAMAs and LAMAs

A

competitively inhibit cholinergic receptors in bronchial smooth muscle

54
Q

SAMA effectiveness

A

less effective then B2 agonists in asthma
slower onset of action than SABAs

55
Q

adverse effects of SAMA & LAMA

A

dry mouth
cough
constipation
urinary retention
headache

56
Q

what is the dosing for the LABAs in COPD?

A

salmeterol and formoterol - BID
indacaterol and olodaterol - OD

57
Q

what are the LAMAs and their dosing?

A

tiotropium - OD
aclindinium - BID
glycopyrronium - OD
umeclidinium - OD

58
Q

what is the difference in LABAs and LAMAs?

A

both improve symptoms
Tiotropium (LAMA) may be superior in decreasing exacerbations
LAMAs may be better tolerated

59
Q

should ICS be used in COPD?

A

should not be used as first line or as monotherapy
they do have some evidence for reducing exacerbations though

60
Q

what kind of combo products are there in COPD?

A

LAMA/LABA
SAMA/SABA
ICS/LABA
LABA/LAMA/ICS

61
Q

what is N-acetylcysteines role in COPD?

A

high dose, 600mg orally BID may reduce exacerbations in those who had 2 or more exacerbations in the previous 2 year period

62
Q

what is roflumilast?

A

a phosphodiesterase IV inhibitor that improves FEV1 and can decrease exacerbations

63
Q

what is the dosing for roflumilast?

A

500mcg tab OD added on to bronchodilator treatment

64
Q

side effects of roflumilast

A

diarrhea
weight loss
nausea
headache
sleep disturbances

65
Q

pros and cons of theophylline in COPD

A

pros - effective bronchodilator taken OD or BID
cons - serious drug toxicity may occur, and several potential drug interactions

66
Q

low risk of exacerbations

A

1 or less moderate exacerbation in the last year

67
Q

high risk of exacerbations

A

2 moderate or 1 severe exacerbation in the last year requiring hospital admissions/ED visit

68
Q

drug treatment of mild COPD

A

SABA prn and LAMA or LABA

69
Q

drug treatment for moderate and severe COPD with low risk AECOPD

A

SABA prn + LAMA/LABA combo
step up to LAMA/LABA/ICS if needed

70
Q

drug treatment for moderate and severe COPD with high risk AECOPD

A

SABA prn + LAMA/LABA/ICS
can add on prophylactic macrolide/PDE-4 inhibitor/mucolytic agents if needed

71
Q

what are some other serious therapies for COPD?

A

lung volume reduction surgery
lung transplantation

72
Q

what is an acute exacerbation?

A

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
Q

what is the treatment of acute exacerbations?

A

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
Q

which antibiotics could be used in COPD without risk factors?

A

amoxicillin
doxycycline
cotrimoxazole
(x5-7 days)

75
Q

which antibiotics could be used in COPD with risk factors?

A

amoxi clav (5-10 days)
cefuroxime axetil (5-10 days)
levofloxacin (3-5 days)

PHAR 253 (8 decks)

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