COPD Flashcards
(35 cards)
1
Q
COPD definition
A
- persistent respiratory sx and airflow limitations
- due to airway and/or alveolar abnormalities
- dev fibrosis, alveolar wall destruction, and mucus hypersecretion
2
Q
COPD symptoms
A
- persistent and progressive dyspnea
- chronic cough
- chronic sputum production
- hx of risk factor exposure
- family hx
- hyperinflation
3
Q
risk factors for COPD
A
- smoking
- smoke from cooking/ heating fuels
- occupational
4
Q
COPD phenotypes
A
- chronic bronchitis
- emphysema
- asthma- COPD overlap
- alpha-1 anti-tripsin deficiency (AATD)- hereditary cause
5
Q
chronic bronchitis
A
- chronic cough for 3 mo in each of 2 successive years
6
Q
emphysema
A
- abnormal permanent enlargement of airspaces distal to terminal bronchioles
7
Q
markers for hyperinflation
A
- inspiratory capacity
- functional residual capacity
8
Q
how do you grade severity of COPD
A
- GOLD severity rating
- must have FEV1/ FVC ratio < 70%
- compare FEV1 ratio to predicted value
- graded 1-4
9
Q
GOLD 1
A
- mild
- FEV1 > 80% predicted
10
Q
GOLD 2
A
- moderate
- FEV1 50-80% predicted
11
Q
GOLD 3
A
- severe
- FEV1 30-50% predicted
12
Q
GOLD 4
A
- very severe
- FEV1 < 30%
13
Q
COPD exacerbation
A
- acute worsening of respiratory sx
- requires additional therapy
14
Q
mild COPD exacerbation tx
A
- short acting bronchodilator
15
Q
moderate COPD exacerbation
A
- short acting bronchodilator PLUS abx/steroids
16
Q
severe COPD exacerbations
A
- hospitalization or ED
- possible respiratory failure
17
Q
treatments for exacerbations
A
- bronchodilators
- O2 if hypoxic
- PO or IV steroids- shorten recovery time and improve lung function
- abx- often get superimposed infections
18
Q
group A exacerbation risk/ sx burden
A
- 0 hospitalizations
- 0-1 exacerbations
- mMRC 0-1 or CAT < 10
- tx- bronchodilators
19
Q
group B exacerbation risk/ sx burden
A
- 0 hospitalizations
- 0-1 exacerbations
- mMRC 2+ or CAT 10+
- tx- LAMA or LABA
20
Q
group C exacerbation risk/ sx burden
A
- 1+ hospitalizations
- 2+ exacerbations
- mMRC 0-1 or CAT < 10
- tx- LAMA
21
Q
group D exacerbation risk/ sx burden
A
- 1+ hospitalizations
- 2+ exacerbations
- mMRC 2+ or CAT 10+
22
Q
goals of treatment
A
- relieve sx
- improve exs tolerance
- improve health status
- prevent progression
- prevent exacerbations
- reduce mortality
- generally: reduce sx and risk
23
Q
COPD management cycle
A
- review- sx, exacerbation frequency
- assess- inhaler technique, adherence, non-pharm approaches
- adjust- escalate, switch devices, de-escalate
24
Q
general tx considerations for COPD
A
- inhaled preferred
- combo tx is better than ICS or LAMA alone
- SAMA/ SABA for acute exacerbations only
- maintenance with long acting bronchodilators preferred
25
ICS + LABA combo in COPD
- preferred in pts with asthma- COPD overlap phenotype (eosinophilia)
- regular tx with ICS increases pneumonia risk
26
non-bronchodilator therapies for COPD
- mucolytics
- antitussives
- leukotriene modifiers
- anti-TNF alpha antibodies
- alternative therapies
- vitamin D
- none have been shown to be very effective
27
red flags of COPD treatment
- ICS alone
- OTC cough meds
- poor or erratic adherence
- missed appointments
- avoiding ADLs
- poor technique/ inhaler maintenance
- >1 canister of albuterol per month
- frequent abx or steroids
- therapeutic duplications
28
COPD treatment for dyspnea
- start with LAMA or LABA
- step up to LAMA + LABA
- consider switching drug and/or device, investigate cause of sx
- if pt has eosinophilia can start with ICS + LABA and step up to triple tx
29
COPD treatment for exacerbations
- LAMA or LABA
- step up to LAMA + LABA
- can step up to ICS + LABA if eosinophilia
- step up to triple therapy, roflumilast, or azithromycin
30
eosinophilia cut offs for ICS use
- eosinophilia > 300
| - eosinophilia > 100 and high risk exacerbations
31
respimat steps for use
- soft mist inhaler
- must push cartridge into inhaler with force
- hold inhaler upright, turn base until click
- flip cap and press dose release
32
diskus steps for use
- DPI
- hold inhaler like hamburger
- to load slide lever away from you until it clicks
- breath in forcefully and quickly
33
tudorza pressair steps for use
- DPI
- requires prep
- hold inhaler so it "looks like a sneaker"
- press green button all the way down to release so window turns from red to green
- breath in quickly and deeply until click
- check that the window turned back to red
34
ellipta steps for use
- DPI
- slide cover down to expose mouth piece until click
- dont block air vent
- breath in
- if cover is opened and closed without inhalation dose is lost
- not possible to inhale 2 doses
35
spiriva handihaler
- separate on blister from blister card and load
- press green piercing button until flat against base and release
- hold upright, turn horizontally and breath in
- capsule should vibrate
- dont block vents
- take a SECOND inhale
