COPD

Question 1

Risk factors for COPD

Answer 1

• Exposure to smoke
• Dust/chemicals/fumes
• Pollution
• a1 antitrypsin deficiency
• Hx of severe childhood respiratory infections
• Age over 40
• Socioeconomic status

Question 2

COPD presentation

Answer 2

Dyspnea
Cough** (#1)
Chronic sputum production
Wheezing
Comorbidities

Question 3

COPD diagnosis

Answer 3

Spirometry: Post-bronchodilator FEV1/FVC <0.70

Question 4

GOLD grades

Answer 4

GOLD 1 - FEV1 80 + %
GOLD 2 - FEV1 50-79%
GOLD 3 - FEV1 30-49%
GOLD 4 - FEV1 <30%

Question 5

ABE assessment

Answer 5

E: 2+ moderate exacerbations or 1+ hospitalization
A: At most 1 moderate exacerbation with mMRC 0-1 or CAT <10
B: At most 1 moderate exacerbation with mMRC 2+ or CAT 10+

Question 6

Group A treatment

Answer 6

A bronchodilator (LABA or LAMA)

Question 7

Group B treatment

Answer 7

LABA + LAMA

Question 8

Group E treatment

Answer 8

LABA + LAMA (consider +ICS if blood eos >300)

Question 9

What does every COPD patient need?

Answer 9

SABA and/or SAMA for relief

Question 10

When is roflumilast indicated?

Answer 10

FEV <50% & chronic bronchitis

Question 11

What population does long-term azithromycin have good data in?

Answer 11

Former smokers (exacerbation reduction)

Question 12

Non-pharm for COPD

Answer 12

• Smoking cessation
• Vaccination
• Pulmonary rehabilitation
• Long-term oxygen (PaO2 < 55, Osat <88%)

Question 13

Monitoring COPD

Answer 13

• Annual spirometry
• S/S sleep, exercise ability, SOB
• CAT, mMRC
• Smoking status
• Drug ADEs
• Adherence

Question 14

Asthma/COPD overlap treatment

Answer 14

ICS and consider LABA +/- LAMA

Question 15

Mild exacerbation criteria

Answer 15

• Dyspnea VAS <5
• RR <24
• HR <95
• Resting Osat 92+% or change <3%
• CRP <10 mg/L

Question 16

Moderate exacerbation

Answer 16

(At least 3):
- Dyspnea VAS >5
- RR >24
- HR >95
- Resting Osat <92% or change >3%
- CRP >10 mg/L

Question 17

Severe exacerbation

Answer 17

Moderate criteria PLUS
ABG showing new onset/worsening hypercapnia and acidosis
(PaCO2 >45 and pH <7.35)

Question 18

When should you avoid positive-pressure ventilation?

Answer 18

• Altered mental status
• Severe acidosis (ph < 7.25)
• Respiratory arrest
• Cardiovascular instability

Question 19

Acute COPD exacerbation inpatient treatment

Answer 19

SABA +/- SAMA
- Scheduled nebulizer not recommended inpatient after 3 doses
- Levalbuterol less cardiac effects
40 mg prednisone or equiv. for 5-7 days
Antibiotics? 5-7 days
Oxygen therapy?

Question 20

When should you give oxygen and what is the goal?

Answer 20

Give when Osat <90%
Target 88-92%

Question 21

When should you give antibiotics?

Answer 21

Sputum purulence PLUS:
- Increased dyspnea
AND/OR
- Increased sputum volume

Question 22

COPD exacerbation discharge treatment

Answer 22

LABA +/- LAMA

Question 23

Which antibiotics should NOT be used?

Answer 23

• Erythromycin (doesn’t cover H influ)
• Bactrim (resistance)
• Amox alone, first gen cephalosporins (beta-lactamase sus)

Question 24

Uncomplicated exacerbation

Answer 24

<4 exacerbations per year with no comorbidities

Question 25

Uncomplicated exacerbation treatment

Answer 25

Macrolide (azithro, clarithro)*
2nd or 3rd gen cephalosporin
Doxycycline

Question 26

Complicated exacerbation

Answer 26

Age 65+ and >4 exacerbations per year with comorbidities

Question 27

Complicated exacerbation treatment

Answer 27

Amox/clav
Fluoroquinolone

Question 28

High risk for MDRP

Answer 28

Chronic steroid therapy
Recent hospitalization <90 days
Recent antibiotic therapy <90 days
Resident of LTC

Question 29

Treating when high risk for MDRP

Answer 29

Fluoroquinolone
IV options: 3rd or 4th gen cephalosporin