COPD (exam 2)

Question 1

COPD

Answer 1

Heterogeneous lung condition
Results from airway/alveolar abnormalities

Question 2

Airway abnormalities

Answer 2

bronchitis
bronchiolotis

Question 3

Alveolar abnormalities

Answer 3

emphysema

Question 4

Is COPD reversible?

Answer 4

Not fully

Question 5

Most common risk factor for COPD

Answer 5

Cigarette smoking

Question 6

Additional COPD risk factors

Answer 6

Noxious particles
Alpha-1 antitrypsin deficiency
Older age/female
Asthma

Question 7

Role of alpha-1 antitrypsin

Answer 7

protects cells from destruction by ELASTASE

Question 8

ELASTASE breaks down _____

Answer 8

elastin

Question 9

Low AAT levels causes

Answer 9

increased elastase activity –> lung damage –> COPD

Question 10

COPD pathophysiology

Answer 10

inhalation of noxious particles –> activation of inflammatory cells and mediators

Question 11

Inflammatory cells activated in COPD

Answer 11

Neutrophils
Macrophages
CD8+ T cells

Question 12

COPD impacts the

Answer 12

small + large airways
pulmonary vasculature
lung parenchyma

Question 13

Inflammatory fluid present means

Answer 13

increased goblet cells + mucus glands = increased mucus
impaired ciliary motility
thickening of SM

Question 14

Results of COPD inflammation

Answer 14

Scarring + fibrosis
FEV1 decline
Impaired gas exchange
Air trapping

Question 15

Mediators involved in COPD

Answer 15

LTB-4
IL-8
TNF-a

Question 16

COPD has a ____ response to glucocorticoids

Answer 16

variable
(not rlly used in COPD)

Question 17

Presentation of COPD

Answer 17

cough, sputum production
barrel chest
hypoxemia
hypercapnia

Question 18

Diagnosis of COPD

Answer 18

dyspnea that is progressive + persistent
recurrent wheeze
chronic cough
recurrent lower RTIs
history of smoking

Question 19

Post-bronchodilator FEV1/FVC is ____ of predicted which indicates COPD

Answer 19

< 70%

Question 20

Severity of COPD is classified based on

Answer 20

Airflow obstruction (FEV1)
Patient symptoms (CAT, mMRC)
Exacerbation risk

Question 21

Gold 1

Answer 21

Mild
> 80% predicted

Question 22

Gold 2

Answer 22

Moderate
50-80% predicted

Question 23

Gold 3

Answer 23

Severe
30-50% predicted

Question 24

Gold 4

Answer 24

Very Severe
< 30% predicted

Question 25

COPD assessment tools

Answer 25

COPD Assessment Test (CAT) COPD Control Questionnaire (CCQ) Chronic Respiratory Questionnaire (CRQ) St. George's Respiratory (SGRQ)

Question 26

Tool for assessment of breathlessness ONLY

Answer 26

Modified British Medical Research Council Questionnaire (mMRC)

Question 27

COPD Assessment Test (CAT)

Answer 27

Score 0-40 >10 indicates increased symptoms

Question 28

Modified British Medical Research Council Questionnaire (mMRC)

Answer 28

Score 0-4 Score >2 indicates increased breathlessness

Question 29

LAMAs are _____ effective than LABAs but ____ is better

Answer 29

more LABA+LAMA

Question 30

LAMA+LABA better than either agent alone at

Answer 30

reducing symptoms improving FEV1 reducing exacerbations

Question 31

Mainstay of COPD therapy

Answer 31

LABAs & LAMAs

Question 32

Short Acting Beta2 Agonists (SABAs)

Answer 32

Albuterol Levalbuterol

Question 33

Long Acting Beta2 Agonists (LABAs)

Answer 33

Salmeterol Formoterol Indacaterol Olodaterol Aformoterol

Question 34

Short Acting Muscarinic Antagonists (SAMAs)

Answer 34

Ipratropium Bromide

Question 35

Long Acting Muscarinic Antagonists (LAMAs)

Answer 35

Tiotropium Aclidinium bromide Umeclidinium Glycopyrrolate Revefenacin

Question 36

Combination LABA/LAMA

Answer 36

Anoro Ellipta Stiolto Respimat Bevespi Aerosphere Duaklir Pressair

Question 37

Combination SABA/SAMA

Answer 37

Combivent Duoneb

Question 38

There is an increased risk of ____ in ICS' at high doses

Answer 38

pneumonia

Question 39

Combination ICS/LABA

Answer 39

Advair Symbicort Dulera Breo Ellipta

Question 40

Triple Combination Inhaler

Answer 40

Trelegy Ellipta Breztri Aerosphere

Question 41

PDE4 Inhibitor

Answer 41

Roflumilast (Daliresp)

Question 42

Roflumilast (Daliresp) MOA

Answer 42

reduces inflammation vis cAMP inhibition

Question 43

Roflumilast (Daliresp) Indications

Answer 43

COPD exacerbations

Question 44

PDE3&4 Inhibitor

Answer 44

Ensifentrine (Ohtuvayre)

Question 45

Ensifentrine (Ohtuvayre) MOA

Answer 45

inhibits PDE3&4 --> decreased activation of immune & inflammatory cells

Question 46

Ensifentrine (Ohtuvayre) Indication

Answer 46

Add on therapy to LABA+LAMA for dyspnea

Question 47

Ensifentrine (Ohtuvayre) side effects

Answer 47

Neuropsychiatric events

Question 48

Macrolide Antibiotic

Answer 48

Azithromycin

Question 49

Azithromycin side effects

Answer 49

Hearing impairment Bacterial resistance Diarrhea

Question 50

Azithromycin indication

Answer 50

Exacerbation in former smokers

Question 51

IL-4 Receptor Antagonist

Answer 51

Dupilumab (Dupixent)

Question 52

Dupilumab (Dupixent) MOA

Answer 52

decreases IL-4 --> decreased inflammatory mediators

Question 53

Dupilumab (Dupixent) indication

Answer 53

add on to LABA+LAMA+ICS for exacerbation in patients w/ eos >300

Question 54

AI-Proteinase Inhibitors

Answer 54

Prolastin-C Aralast NP Zemaira Glassia

Question 55

AI-Proteinase Inhibitors are only indication for patients with ____

Answer 55

alpha1-antitrypsin deficiency

Question 56

Other COPD treatments not really recommended

Answer 56

NAC & carbocysteine Guaifenesin Antitussives

Question 57

Initial therapy for group E

Answer 57

LABA+LAMA consider triple therapy

Question 58

Initial therapy for group B

Answer 58

LABA+LAMA

Question 59

Initial therapy for group A

Answer 59

Bronchodilator SABA or SAMA or LABA or LAMA

Question 60

Patients experiencing both dyspnea and exacerbations should use the ____ pathway.

Answer 60

exacerbation

Question 61

Nonpharmacological treatment for group A

Answer 61

Smoking cessation Physical activity Vaccines

Question 62

Nonpharmacological treatment for groups B and E

Answer 62

Smoking cessation Pulmonary rehabilitation Physical activity Vaccines