COPD

Question 1

COPD is the fourth

Answer 1

leading cause of death among adults

Question 2

COPD is

Answer 2

Persistent respiratory symptoms and
airflow limitation, due to airway and/or
alveolar abnormalities, usually caused by
significant exposure to noxious particles or
gases

Question 3

COPD is made up of what two conditions

Answer 3

Obstructive bronchiolitis and emphysema

Question 4

Gold Initiative for Chronic

Obstructive Lung Disease (GOLD) uses what to evaluate severity

Answer 4

• Uses the forced expiratory volume in one
second (FEV1).
• Severity of symptoms, risk of exacerbation,
presence of comorbidities; disease pattern.
• COPD Assessment Tool (CAT) or modified
Medical Research Council (mMRC) dyspnea
scale
• Symptoms and risk components are
combined into four groups.

Question 5

COPD Managment (5 items)

Answer 5

• Smoking cessation
• Reduction of other risk factors (e.g.,
exposure to open cooking fires)
• Vaccinations,
• Oxygen therapy
• Pulmonary rehabilitation.

Question 6

Classifications of COPD

Answer 6

– Mild
– Moderate
– Severe
– Very severe

Question 7

Gold 1 Mild FEV

Answer 7

> 80

Question 8

Gold 2 Moderate FEV

Answer 8

50 to 79

Question 9

Gold 3 Severe FEV

Answer 9

30 to 49

Question 10

Gold 4 Very Severe FEV

Answer 10

<30

Question 11

Gold ABCD grading

Answer 11

Multidimensional assessment of COPD that uses symptoms and risk of exacerbation

Question 12

Group A:

Answer 12

Few symptoms; low risk

Question 13

Group B

Answer 13

Increased symptoms; low risk

Question 14

Group C

Answer 14

Few symptoms; high risk

Question 15

Group D

Answer 15

Increased symptoms; high risk

Question 16

Treatment goals for CPOD

Answer 16

Reduce symptoms, thereby improving the
patient’s health status and exercise tolerance

– Reduce risks and mortality by preventing
progression of COPD and by preventing and
managing exacerbations

Question 17

COPD all categories should

Answer 17

avoid risk factors such as smoking

flu vaccine

pneumoccal vaccine

regular physical activity

regular review/correction of inhaler technique

long-term oxygen therapy if chronic hypoxemia

pulmonary rehab

Question 18

Category A Treatment

Answer 18

Minimally symptomatic, low risk of exacerbation

• Short-acting bronchodilator (SABA or anticholinergics)
• Can add a long-acting bronchodilator, if
symptoms inadequately controlled with
short-acting bronchodilator
• Combination therapy (albuterol plus
ipratropium)

Question 19

Category B Treatment

Answer 19

More symptomatic, but at low risk of exacerbation

• Long-acting bronchodilator (beta agonist
or anti-muscarinic agent)
• Combined bronchodilator therapy
– Triotropium-olodaterol
– Umclidiniuum-vilanterol
– Glycopyrronium-indacterol

Question 20

Category C Treatment

Answer 20

Minimally symptomatic on a day-to-day basis
but are at a high risk for an exacerbation

• LAMA (initial)
• Both a LAMA and a long-acting beta agonist
(LABA)
• Both a LABA and an inhaled glucocorticoid
(ICS)

• Less preferred options include regular use of
short-acting beta-agonist and/or short-acting muscarinic agent; a phosphodiesteras-4
inhibitor, or theophylline

Question 21

Category D

Answer 21

Higher symptom burden and a high risk of
exacerbation

• Triple therapy – GC-LABA-LAMA

Question 22

COPD approach

Answer 22

Step-wise fashion
– Bronchodilators (beta agonist and anticholinergics)
– Glucocorticoids (inhaled)
– Phosphodiesterase-4 inhibitors

Question 23

COPD Exacerbation Management

Answer 23

– SABAs (specifically inhaled, either alone or in
combination with inhaled anticholinergics) are
preferred for bronchodilation during COPD
exacerbations
– Systemic glucocorticoids
– Antibiotics
– Supplemental oxygen to maintain an oxygen
saturation of 88% to 92%

Question 24

Phosphodiesterase-4 Inhibition reduce

Answer 24

Reduce risk of COPD exacerbations in

patients with a history of frequent COPD

Question 25

Phosphodiesterase-4 Inhibition decrease

Answer 25

• Decreases inflammation and may promote airway smooth muscle relaxation • Roflumilast

Question 26

Phosphodiesterase-4 Inhibition example

Answer 26

Roflumilast

Question 27

Phosphodiesterase-4 Inhibition may be associated with

Answer 27

May be associated with an increase in adverse psychiatric reaction, should be used in caution in patients with a history of depression.

Question 28

Phosphodiesterase-4 Inhibition SE

Answer 28

: insomnia, diarrhea, nausea, vomiting, | weight loss, and dyspepsia.

Question 29

COPD is a

Answer 29

a common condition with a high mortality

Question 30

• The Global Initiative for Chronic Obstructive Lung Disease | (GOLD) has developed a

Answer 30

categorization system for COPD severity. Defines disease severity according to the frequency and severity of symptoms and the risk of exacerbations and hospitalization. Use this as a guide for the management of patients with stable COPD. Assess symptoms using the modified Medical Research Council (mMRC) dyspnea scale or the COPD Assessment Test (CAT).

Question 31

For all patients prescribe a

Answer 31

short-acting bronchodilator (e.g., a beta-agonist, anticholinergic agent) on an as-needed basis for relief of acute COPD symptoms.

Question 32

Consider a combination of a

Answer 32

SABA and a short-acting muscarinic agent to achieve a greater acute bronchodilator benefit. Those on a long-acting anticholinergic agent, a short- acting beta agonist is generally used for quick relief of COPD symptoms.

Question 33

Monitoring

Answer 33

• Routine monitoring of symptoms

Question 34

Oxygen — long-term supplemental oxygen therapy is recommended for

Answer 34

chronic hypoxemia (PaO2 ≤55 mmHg or SpO2 ≤88 percent).

Question 35

"Long-term oxygen therapy (LTOT) increases

Answer 35

survival and improves the quality of life of hypoxemic patients with chronic obstructive pulmonary disease (COPD) and is often prescribed for other patients with hypoxemic chronic lung disease" (Tiep, & Carter, 2019).

Question 36

Comprehensive pulmonary rehabilitation – improves

Answer 36

exercise capacity, improve quality of life, decrease dyspnea, and decreases health care utilization.

Question 37

Phosphodiesterase-4 (PDE-4) inhibitor [roflumilast] - approved to

Answer 37

reduce the risk of COPD exacerbations in patients with a history of frequent COPD exacerbations (e.g., at least two per year or one requiring hospitalization)