COPD

Question 1

COPD Characteristics

Answer 1

• Onset: Usually > 40 yo
• Smoking hx: Usually > 10 y
• Sputum production common
• Allergy hx uncommon
• Sxs are persistent and disease progresses/gets worse with time
• Exacerbations are a common complications
• First-line tx: Bronchodilator

Question 2

Asthma Characteritics

Answer 2

• Onset: Usually < 40 yo
• Smoking hx: uncommon
• Sputum production is infrequent
• Allergy hx is common
• Sxs are intermittent and variable, disease doesn’t progress over time (stable)
• Exacerbations are a common complication
• First-line tx: ICS

Question 3

COPD Sxs Assessment Tools

Answer 3

• mMRC

- CAT

Question 4

Group A COPD/Tx

Answer 4

• CAT < 10
• mMRC 0-1
• 0 or 1 exacerbation hx (not leading to hospitalization)
• Tx: Bronchodilator! (SAMA or SABA PRN, better outcomes combined, LAMA or LABA)

Question 5

Group B COPD/Tx

Answer 5

• CAT >=10
• mMRC >= 2
• 0 or 1 exacerbation hx (not leading to hospitalization)
• Tx: LAMA or LABA

Question 6

Group C COPD/Tx

Answer 6

• CAT < 10
• mMRC 0-1
• > =2 exacerbations or 1+ leading to hospitalization
• Tx: LAMA

Question 7

Group D COPD/Tx

Answer 7

• CAT >=10
• mMRC >= 2
• > =2 exacerbations or 1+ leading to hospitalization
• Tx: LAMA or LAMA+LABA (highly sxs) or LABA+ICS (eos >= 300)

Question 8

Atrovent

Answer 8

-Ipratropium
-SAMA
2 inh QID

Question 9

Combivent Respimat

Answer 9

• Ipratropium + Albuterol
• SAMA + SABA
• 1 inh QID

Question 10

Spiriva

Answer 10

• Tiotropium
• LAMA
• Handihaler or Respimat
• Handihaler (DPI): 1 cap via device QD (2 puffs needed)
• Respimat (MDI): 2 inh QD

Question 11

Muscarinic Antagonist Information

Answer 11

• SE: Dry mouth
• Monitor: smoking status, COPD questionnaires, annual spirometry
• Don’t swallow capsules for DPIs! (Handihaler/Neohaler products)
• Turdoza Pressair: DPI, want indicator to switch from green to red when dose is inhaled properly

Question 12

Daliresp

Answer 12

• Roflumilast
• PDE4i that reduces lung inflammation
• CI: Moderate to severe liver impairment
• SE: Diarrhea, weight loss
• Reserved for patients with severe COPD and must be used with a LAMA or LABA

Question 13

COPD

Answer 13

• Chronic/progressive dyspnea (SOB), cough, sputum, production
• Common cause: tobacco smoke exposure
• AAT deficiency is also a risk factor for COPD (usually protects lungs from damage)

Question 14

Dyspnea Escalation

Answer 14

• LAMA OR LABA (whichever not used first usually)
• LAMA + LABA
• Switch inhalers/check for other causes if still not controlled

Question 15

SOB Escalation

Answer 15

• LAMA OR LABA (whichever not used first usually)
• LAMA + LABA OR LAMA + ICS if eos >=300
• If either of the 2nd line is failed, can do triple therape LAMA + LABA + ICS (only add ICS to dual therapy if eos >= 100)
• If failing LAMA + LABA dual therapy and eos < 100, consider adding daliresp