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Clinical 2.0 winter > COPD > Flashcards

COPD Flashcards

1
Q

why is COPD the only common cause of death thats increased in prevelance over the last 40 years

A

no medications that decrease mortality

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2
Q

COPD vs asthma age of onset

A

asthma young

copd over 40

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3
Q

copd vs asthma smoking history

A

copd usually smokers

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4
Q

copd vs asthma sputum production

A

infrequent with asthma

often with copd

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5
Q

copd vs asthma allergies

A

allergies common in asthma not copd

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6
Q

copd vs asthma clinical symptoms

A

asthma intermittent and variable

copd persistent

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7
Q

copd vs asthma disease course

A

asthma stable with exacerbations and spirometry normalizes

copd is progressive worsening will never normalize

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8
Q

what are some reversible tings in copd

A

presence of mucus and inflammatory cells and mediators in bronchial secretions
bronchial smooth muscle contraction in peripheral and central airways
dynamic hyperinflation during exercise

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9
Q

what are some irreversible things in copd

A

fibrosis and narrowing of airways
reduced elastic recoil with loss of alveolar surface area
destruction of alveolar support with reduced patency of small airways

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10
Q

what is the most effective wat to reduce decline in lung function

A

stop smoking

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11
Q

diagnosis of copd

A

post bronchodilator FEV1/FVC ratio of 70%

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12
Q

what is mild copd

A

SOB when hurrying or walking up a slight hill
FEV >80%
FEV/FVC

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13
Q

what is moderate copd

A

SOB causes patient to stop after walking 100m level
5080 predicted
FEV/FVC

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14
Q

what is severe copd

A

SOB prevents patient from leaving the house
breathless when dresing

30

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15
Q

treatment for mild copd

A

SABA as needed

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16
Q

treatment of worsening mild copd

A

add a LAMA or LABA to the SABA

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17
Q

if a LABA or LAMA alone does not work what is the next step

A

LAMA/LABA combo

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18
Q

treatment for asthma copd overlap

A

ICS and LABA

if uncontrolled add LAMA or increase dose

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19
Q

important patient outcomes

A 
QOL 
dyspnea scores
rescue inhaler use
walking disance
exacerbations
mortality
20
Q

what is statistical sig

A

establishing the difference shown is not due to chance

21
Q

what is clinical sig

A

is the result sig to the patient

22
Q

on the SGRQ quality of life questionnare how many points are clinically sig

A

4 points

23
Q

what is a simple exacerbation

A

< 4 in a year and at least 2 of:

increased sputu, purulence or volume and or increased dyspnea

24
Q

treatment for a simple exacerbation

A

amox
doxycyline
sulfatrim
5-7 days

25
Q

whats a complicated exacerbation

A 
>4 and at least 2 of:
1. increased sputum purulence
2. increased sputum volume
3. increased dyspnea 
failure of first line agents
antibiotics in the past 3 months
26
Q

treatment for complicated exacerbation

A

amox clav
cefuroxime
levo
alternative: azithro, clarithro

27
Q

how is prednisone used in acute exacerbations

A

50mg for 5 days (just as good as 14 days)

increases FEV1 and decreases treatment failure

28
Q

do you need to taper prednisone after a 2 week use

A

no

29
Q

side efffects of tiotropium

A

dry mouth

30
Q

side effects of salmeterol

A

tremor, increase HR, nervous

31
Q

is a LAMA or LABA better?

A

LAMA may be a tiny bit better but CPG recommends either one comes down to the patient preference

32
Q

examples of LAMAs

A

glycopyrronnium
tiotropium
aclidinium
umeclidinium

33
Q

new LAMAs compared to tiotropium

A

no difference just depends what type of inhaler they prefer

34
Q

does tiotropium really reduce hospitalizations by 30% more than glycopyrronium?

A

30% is a relative number not absolute only 0.04 hospitalizations so there is no difference

35
Q

LABA options

A

indacaterol
formoterol
salmeterol

36
Q

mechanism of the LAMA LABA combo

A

relax airway smooth muscle by direct inhibition of cholinergic activity and
antagonism of bronchoconstriction via beta 2 adrenergic pathways

37
Q

what is transition dyspnea index and how many points would you want it to change

A

evaluative instrument that measures changes in dyspnea compared to baseline
3 for clinical sig

38
Q

is a LAMA LABA combo better than on their own

A

may prevent 1 exacarbation but no difference in hospitalizations
not overal much of a benefit but no increase in adverse events

39
Q

if combo was successful what would you do

A

combo inhaler because cheaper than 2 separate inhalers

40
Q

if combo is not successful what do you do

A

check in 4 weeks if not successful stop

41
Q

what is pulmonary rehab and whats it for

A

multidisciplinary team that educates/trains/counsels/supports for 6-8 week - smoking cessation, exercise, nutrition, physcosocial
any patient with disabling copd symptoms

42
Q

benefits of pulmonary rehab

A

improve dyspnea and quality of life
seen in sizes beyond clinical sig
improve hospitalization and mortality

43
Q

what do you give if someone is uncontrolled on LAMA LABA combo

A

LAMA + ICS/LABA

insufficient evidence that there is any additional benefit

44
Q

why is LAMA + LABA preferred over ICS + LABA

A

LAMA LABA modestly better and is safer

ICS and LABA causes pneumonia in these patients

45
Q

does removing fluticasome from the lama and laba cause mroe exacerbations

A

no cant justify used for ICS in COPD unless that have asthma

46
Q

non pharms

A 
pneumococcal and influenza shot 
smoking cessation 
pulmonary rehab 
CVD risk reducation 
track adherence and technique
47
Q

if someone was on ICS already what would be good indications to stop

A

no additional benefit in a yea or had several peumonias

Clinical 2.0 winter (28 decks)

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