COPD Flashcards
(133 cards)
1
Q
COPD definition
A
Common, preventable and treatable disease that is characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases
2
Q
What are the 3 most common indicators for COPD
A
Dyspnea, chronic cough, chronic sputum production
3
Q
What are some associated considerations with dyspnea?
A
Persistent, progressive, worse with exercise/activity
4
Q
What are some associated considerations with chronic cough?
A
May be intermittent and unproductive
5
Q
What are some associated considerations with chronic sputum production?
A
Any chronic pattern of production may indicate COPD
6
Q
COPD symptoms pattern
A
Chronic, usually continuous;worse with exercise
7
Q
Asthma symptom pattern
A
Vary day-to-day, associated with triggers
8
Q
What is the history for COPD?
A
Exposure to noxious particles and gases
9
Q
What is the history for asthma?
A
Allergies and history of asthma+/- family history of asthma
10
Q
What causes airway inflammation in COPD?
A
Neutrophils and/or eosinophils
11
Q
What causes airway inflammation in asthma?
A
Eosinophils and/or neutrophils
12
Q
What are some COPD phenotypes?
A
Chronic bronchitis, emphysema, asthma-COPD overlap, alpha-1 antitrypsin deficiency
13
Q
Chronic bronchitis
A
Chronic productive cough for 3 mos in each of 2 successive years when other causes of chronic cough have been excluded
14
Q
Emphysema
A
Abnormal permanent enlargement of airspace’s distal to the terminal bronchioles
15
Q
What is consistent with a diagnosis of COPD?
A
Any chronic pattern of sputum production may indicate COPD
16
Q
What is the gold standard for COPD diagnosis?
A
Lung function assessment: Spirometry
17
Q
What 2 main areas are tested with spirometry?
A
The amount of air exhaled
The speed in which air is exhaled
18
Q
The amount of air exhaled
A
Volume
19
Q
The speed in which air is exhaled
A
Flow
20
Q
FEV1
A
Forced expiratory volume in1 second: volume of air expired in the 1st second of the maneuver
21
Q
Volume of air spired in the 1st second of the maneuver
A
FEV1
22
Q
FVC
A
Forced vital capacity: the total volume of air forcibly exhaled in one breathe
23
Q
The total volume of air forcibly exhaled in one breath
A
FVC
24
Q
FEV1/FVC ratio
A
The fraction of air exhaled in the 1st second relative to the total volume exhaled
25
An obstructive disorder is when the FEV1/FVC ratio is what?
< or equal to 70%
26
Mild severity is if the FEV1 is what?
>80% predicted
27
Moderate severity is if the FEV1 is
>50-80% predicted
28
Severe is if the FEV1 is what
>30-50% predicted
29
Very severe is if the FEV1 is what
<30% predicted
30
What is the role of spirometry in follow up care?
Identifies rapidly declining lung function, non-pharmacological interventions, can be used to help rule out alternative diagnoses
31
According to the GOLD guidelines, what PFT result would be consistent with a COPD diagnosis?
FEV1/FVC <70%
32
What are the goals of COPD therapy?
Relieve symptoms, improve exercise tolerance, improve health status, prevent progression, prevent and treat exacerbation, reduce mortality
33
Mild management of COPD
Short acting bronchodilators only
34
Moderate management for COPD
Short acting bronchodilators PLUS Abx and/or oral corticosteroids
35
Management for severe COPD
Requires hospitalization or visits the ED may also be associated with respiratory failure
36
What is the treatment for a COPD exacerbation?
O2 and obtain an ABG, Short acting agents as a bronchodilator (or combo of beta 2 agonist and anticholinergic), oral or IV steroids, Abxs
37
Why is oxygen needed during an acute exacerbation?
Hypoxia, want to obtain ABG after 30-60 mins to ensure no acidosis
38
What type of bronchodilator treatment may be preferable during and exacerbation?
Short acting agents
39
Why are oral or IV steroids added for exacerbations?
Shorten recovery time, improve lung function (FEV1) and hypoxemia, reduce relapse and treatment failure
40
What is the mMRC or the CAT?
Evaluate the symptom burden, COPD assessment tests
41
What would a high symptoms burden score be for the mMRC?
Greater than a 2
42
What would a high symptom burden be for the CAT?
Greater than 10
43
What is Group A for COPD risk groups?
Less symptoms, low exacerbation risk
44
What is group B?
More symptoms, low exacerbation risk
45
What is group C?
Less symptoms, high exacerbation risk
46
What is group D?
More symptoms, high exacerbation risk
47
Which two groups have greater than 1 hospitalization?
C and D
48
Which two groups have a high mMRC and CAT>?
B and D
49
Which two groups have a high exacerbation risk?
C and D
50
Which two groups have less symptoms?
A and C
51
Which two groups have more symptoms?
B and D
52
What are the SABAs?
Albuterol (Proair, Proventil, Ventolin)
| Levalbuterol (Xopenex)
53
What is a SAMA?
Ipratropium (Atrovent)
54
What are the examples of the LABAs?
```
Salmeterol (Serevent)
Formoterol (Perforomist)
Arformoterol (Brovana)
Indacaterol (Arcapta)
Olodaterol (Striverdi)
Vilanterol (in combos only)
```
55
What are the LAMAs?
Aclidinium (Tudorza)
Glycopyrrolate (Seebri)
Tiotropium (Spiriva)
Umeclidinium (Incruse)
56
Regular use of what improves FEV1 and symptoms?
SABA or SAMA
57
What route is preferred for bronchodilators?
Inhaled
58
What significantly improve FEV1, dyspnea, health status and decrease exacerbation rates?
LABAs and LAMAs
59
Combination therapy is superior to what?
To either class alone at improving FEV1 and symptoms
60
LAMAs have a greater effect on exacerbation reduction compared with?
LABAs
61
SABA +/- SAMA are recommended for what?
Initial bronchodilators to treat an acute exacerbation
62
PRN use of short acting bronchodilators can offer additional what?
Benefit when added to long acting bronchodilator regimens
63
SAMAs may be preferred over SABAs when used as what?
Monotherapy in prevention acute mild-moderate exacerbations in pts with mod-severe COPD
64
Atrovent HFA
Ipratropium Bromide; SAMA short acting antimuscarinic
65
What is the indication for Atrovent HFA (Ipratropium Bromide)?
Maintenance treatment of bronchospasm associated with COPD
66
Combivent
Ipratropium + Albuterol
| Short acting bronchodilator combo
67
Indication for Combivent
COPD uncontrolled on a regular aerosol bronchodilator and require a second
68
DuoNeb
Albuterol + Ipratropium
69
Which is preferred for beta-2 agonists and antimuscarinics?
Long-acting formulations
70
Serevent
Salmeterol
| Long acting Beta agonist (LABA)
71
Foradil
Formoterol;
| LABA
72
Arcapta
Indacaterol; LABA
73
Striverdi
Olodaterol; LABA
74
Brovana
Arformoterol; LABA for nebulizer
75
Brovana (Aformoterol) features
Store in fridge, dont combine with other nebulizer solutions
76
Perforomist
Formoterol Fumarate; LABA for nebulizer
77
Perforomist (Formoterol Fumarate) features
Store in fridge, dont combine with other nebulizer solutions
78
Tudorza
Aclidinium; long acting antimuscarinic LAMA
79
Spiriva
Tiotropium; LAMA
80
Incruse
Umeclidinium; LAMA
81
Seebri
Glycopyrrolate; LAMA
82
What is the correct treatment for group A in COPD risk groups?
Short or long acting bronchodilator
83
How can we evaluate the effect of the short or long acting bronchodilator in group A?
Continue, stop, or try alternative bronchodilators
84
What is the treatment for group B?
LAMA or LABA
85
What needs to be done if someone in group B on either a LAMA or LABA has persistent symptoms?
Put them on a LAMA AND a LABA
86
What is the correct treatment for someone in group C?
LAMA
87
If group C has further exacerbations,
LAMA + LABA is preferred; could do a LABA + ICS
88
What is the treatment for someone in group D?
LAMA + LABA
89
If someone in group D has further exacerbations,
LAMA + LABA + ICS
90
If someone in group D who’s on LAMA + LABA + ICS still has exacerbations,
Consider Roflumilast if FEV1 <50%; Consider macrolide (former smokers)
91
Anoro/Ellipta
Umeclidinium/Vilanterol; LAMA + LABA
92
Stiolto/Respimat
Tiotropium/Olodaterol; LAMA + LABA
93
Utibron/Neohaler
Glycopyrrolate/Indacaterol; LAMA + LABA
94
Bevespi/Aerosphere
Glycopyrrolate/Formoteraol LAMA + LABA
95
RegularIm treatment with ICS increases the risk of what?
Pneumonia, especially for those with severe disease
96
Triple ICS/LAMA/LABA does what?
Improves lung fxn, symptoms, and health status and reduces exacerbations compared to ICS/LABA or LAMA monotherapy
97
What is a once daily ICS/LABA combo therapy?
Breo Ellipta
98
Fluticasone Furoate/vilanterol
Breo Ellipta
99
Features of Breo Ellipta
No cleaning, priming, no shaking
100
All respimat devices expire in how long?
90 days
101
All Ellipta devices expire when?
6 weeks
102
What is a once daily ICS/LABA/LAMA triple therapy?
Trelegy Ellipta
103
Fluticasone Furoate/ vilanterol/ umeclidinium
Trelegy Ellipta
104
Trelegy Ellipta
Long-term once daily maintenance treatment of pts with COPD
105
What group can the ICS/LABA/LAMA Therapy be given in?
Group D
106
What is a selective PDE-4 inhibitor used for COPD?
Roflumilast (Daliresp)
107
Who can be on Roflumilast?
Once daily add on in pts not controlled on bronchodilator, group D
108
Pros to Roflumilast
Oral capsule, weight loss, may decrease exacerbation frequency
109
What are the cons to Roflumilast?
Psyc disturbances? Metabolized mostly via CYP3a4 and CYP1A2
| Measure most common adverse effect
110
Consider ABX therapy if patient exhibits:
Signs of lower resp tract infection, severe exacerbation requiring mechanical ventilation
111
What are the 3 cardinal symptoms of an infection in COPD?
Increased dyspnea, increased sputum production, increased sputum purulence
112
What are some non-bronchodilator options?
Mucolytics, Antitussives, Leukotriene Modifiers, Anti-TNF alpha antibody, VitD
113
What Mucolytics can be used?
N-acetylcysteine, Carbocysteine
114
How can mucolytics help?
May reduce exacerbations and improve health status in certain populations
115
What is part of pulmonary rehab?
Exercise training, education, psychological counseling, nutritional counseling
116
Which groups of COPD can benefit from pulm rehab?
B C and D
117
What are some dual combination products?
Aclidinium Bromide + Formoteral Fumarate DPI
118
What are some triple therapy combos?
Budesonide + Glycopyrronium + Formoterol
| Beclometasone + Glycopyrrolate + Formoterol
119
What treatment option has been proven to slow the progression of COPD?
Smoking cessation
120
Which vaccine should a vaccine-naive person aged >65 years get?
PCV13 at age > 65 years
121
Person who previously received PPSV23 at age >65 years
PPSV23 already received, get PCV13 > 1 year
122
Person who previously received PPSV23 before 65 who are now >65
PPSV23 already received at age <65, PCV13 at age > 65, PPSV23 1 year later
123
DPIs must be inhaled more forcefully and rapidly than an MDI?
True
124
All MDIs should be cleaned weekly
True
125
DPIs should be cleaned with water
False
126
DPIs can be used with a spacer
False
127
Positioning is important when loading doses for na MDI or DPI
True
128
All MDIs should be shaken prior to use
False
129
MDIs can be placed in a bowl of water to determine the number of remaining doses?
False
130
What are some common red flags of COPD management?
ICS alone, OTC cough med, poor or erratic adherence, >1 canister of albuterol/month, frequent ABX or oral steroids, therapeutics duplication
131
What needs to be shaken well for 5 seconded before EACH spray?
Symbicort HFA
132
Soft Mist Inhaler for COPD
Spiriva Respimat
133
Soft mist inhaler for asthma
Spiriva Respimat
