LECTURES 29 & 30 - COPD

Question 1

List factors that increase the risk of COPD exacerbation

Answer 1

• Smoking (or secondhand smoke)
• Respiratory infections (viral / bacterial)
• Exposure to air pollution / environmental irritants
• Low lung function (low FEV1) → < 80%
• Comorbidities (heart disease, diabetes), old age

Question 2

What initial pharmacological treatment should be recommended for a patient with >/= 2 moderate exacerbations?

Answer 2

LABA + LAMA

Question 3

What blood eos level would indicate the possible need for an ICS being added to a initial LABA + LAMA treatment?

Answer 3

> /= 300

Question 4

If a patient with >/= 2 moderate exacerbations and no previous treatment has a blood eos level of < 300, should an ICS be added? Why?

Answer 4

No, an ICS should only be considered if blood eos >/= 300

Question 5

What initial pharmacological treatment should be recommended for a patient with >/= 1 exacerbation(s) that led to hospitalization?

Answer 5

LABA + LAMA

Question 6

If a patient with >/= 1 exacerbation(s) that led to hospitalization and no previous treatment has a blood eos level of 300, should an ICS be added? Why?

Answer 6

Yes, you should consider adding an ICS if the blood eos >/= 300

Question 7

What initial pharmacological treatment should be recommended for a patient with:
- 1 exacerbation that did not lead to hospitalization
- mMRC = 0
- CAT = 9

Answer 7

A bronchodilator

because:
mMRC = 0-1
CAT < 10

Question 8

What initial pharmacological treatment should be recommended for a patient with:
- NO exacerbations
- mMRC = 0
- CAT = 9

Answer 8

A bronchodilator

because:
mMRC = 0-1
CAT < 10

Question 9

What initial pharmacological treatment should be recommended for a patient with:
- NO exacerbations
- mMRC = 3
- CAT = 11

Answer 9

LABA + LAMA

because:
mMRC >/= 2
CAT >/= 10

Question 10

What initial pharmacological treatment should be recommended for a patient with:
- 1 exacerbation that did not lead to hospitalization
- mMRC = 3
- CAT = 11

Answer 10

LABA + LAMA

because:
mMRC >/= 2
CAT >/= 10

Question 11

If a patient has 0-1 moderate exacerbations that do not lead to hospitalization, what treatment(s) could be suggested?

Answer 11

A bronchodilator
LABA + LAMA

Question 12

What factors determine the preferred suggested treatment with 0-1 exacerbations that did not lead to hospitalization?

Answer 12

mMRC 0-1 OR >/=2
CAT < 10 OR >/= 10

Question 13

List the potential treatments for a patient with 0-1 moderate exacerbations

Answer 13

A bronchodilator - (mMRC 0-1, CAT <10)

LABA + LAMA - (mMRC >/= 2, CAT >/= 10)

Question 14

List the brand names of LABAs

Answer 14

Brovana
Perforomist
Striverdi
Serevent

Question 15

List the generic names of LABAs

Answer 15

arformoterol
formoterol
olodaterol
salmeterol

Question 16

List the brand/generic names of LABAs

Answer 16

Brovana - arformoterol
Perforomist - formoterol
Striverdi - olodaterol
Serevent - salmeterol

Question 17

What is Perforomist / formoterol available as?

Answer 17

nebulizer

Question 18

What is Brovana / arformoterol available as?

Answer 18

nebulizer

Question 19

What is Striverdi / olodaterol available as?

Answer 19

Respimat

Question 20

What is Serevent / salmeterol available as?

Answer 20

Diskus

Question 21

List the brand names of LAMAs

Answer 21

Spiriva
Incruse

Question 22

List the generic names of LAMAs

Answer 22

tiotropium
umeclidinium

Question 23

List the brand/generic names of LAMAs

Answer 23

Spiriva - tiotropium
Incruse - umeclidinium

Question 24

What is Spiriva / tiotropium available as?

Answer 24

Respimat (2.5 mcg)
Handihaler

Question 25

What is Incruse / umeclidinium available as?

Answer 25

Ellipta

Question 26

List the brand names of LABA + LAMAs

Answer 26

Stiolto Anoro

Question 27

List the generic names of LABA + LAMAs

Answer 27

tiotropium / olodaterol Umeclidinium / vilanterol

Question 28

List the brand/generic names of LABA + LAMAs

Answer 28

Stiolto - tiotropium / olodaterol Anoro - umeclidinium / vilanterol

Question 29

What is Stiolto (tiotropium / olodaterol) available as?

Answer 29

Respimat

Question 30

What is Anoro (umeclidinium / vilanterol) available as?

Answer 30

Ellipta

Question 31

List factors that "strongly favor use" of ICS treatment with long-acting bronchodilators

Answer 31

- History of hospitalization(s) for exacerbations of COPD - >/= 2 moderate exacerbations of COPD per year - Blood eosinophils >/= 300 cells/mcL - History of, or concomitant asthma

Question 32

List factors that "favor use" of ICS treatment with long-acting bronchodilators

Answer 32

- 1 moderate exacerbation of COPD per year - Blood eosinophils 100 to 300 cells/mcL

Question 33

List factors that indicate "against use" of ICS treatment with long-acting bronchodilators

Answer 33

- Repeated pneumonia events - Blood eosinophils < 100 cells/mcL - History of mycobacterial infection

Question 34

If the patient is ALREADY being treated for COPD, and their treatment needs to be adjusted for an exacerbation, what needs to be considered to choose the best treatment?

Answer 34

blood eos levels (< 300 or >/= 300)

Question 35

If the patient is ALREADY being treated for COPD, and their treatment needs to be adjusted for an exacerbation, what is the suggested treatment if their blood eos levels are < 300?

Answer 35

change from LABA / LAMA --> LABA + LAMA

Question 36

If the patient is ALREADY being treated for COPD, and their treatment needs to be adjusted for an exacerbation, what is the suggested treatment if their blood eos levels are >/= 300?

Answer 36

LAMA / LABA -or- LAMA + LABA --> LABA + LABA + ICS

Question 37

If the patient is ALREADY being treated for COPD (with LABA+LAMA), and their treatment needs to be adjusted for an exacerbation, what could be considered for treatment if their blood eos levels are < 100?

Answer 37

The patient could be considered for treatment with: - Roflumilast (FEV1 < 50% & chronic bronchitis) - Azithromycin (preferentially in former smokers)

Question 38

If the patient is ALREADY being treated for COPD (with LABA+LAMA), and their treatment needs to be adjusted for an exacerbation, what could be considered for treatment if their blood eos levels are >/= 100?

Answer 38

an ICS should be added to their LABA + LAMA (LABA + LAMA + ICS)

Question 39

If the patient is ALREADY being treated for COPD (with LABA+LAMA+ICS), and their treatment needs to be adjusted for an exacerbation, what could be considered for treatment if their blood eos levels are >/= 300?

Answer 39

The patient could be considered for treatment with Dupilumab (chronic bronchitis)

Question 40

If both dyspnea & exacerbation risk reduction is needed, which pathway should be utilized?

Answer 40

the exacerbation pathway