COPD Flashcards by Sara Bojarski

obstructed airflow from the lungs, commonly cause by tobacco smoke

COPD

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destruction of the small passages of the lungs

emphysema

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inflammation of the bronchial tubes causing mucus production

bronchitis

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patients with what gena higher risk of developing COPD

alpha-1 antitrypsin (AAT) deficiency

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chronic progressive symptoms indicative of COPD

dyspnea, cough, sputum production

risk factors- smoking

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limitation of airflow in COPD is not

not fully reversible

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what is required to diagnose COPD

spirometry
post bronchodilator FEV1/FVC <0.70

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age of onset of COPD vs asthma

COPD >40
asthma <40

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smoking history in COPD vs asthma

COPD >20 years
asthma uncommon

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sputum production in COPD vs asthma

COPD - common
asthma- uncommon

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allergies in COPD vs asthma

COPD - uncommon
asthma - common

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presence of symptoms in COPD vs asthma

COPD - persistent
asthma - intermittent & variable

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disease process of COPD vs asthma

COPD - progressive, worsens with time
asthma- stable, does not worsen over time

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exacerbations in COPD vs asthma

common complications of both

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what is used to assess severity of airflow limitation of COPD

post bronchodilator FEV1
GOLD guidelines

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first line treatment of COPD vs asthma

COPD - bronchodilators
asthma - inhaled ICS

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FEV1 in each of the GOLD categories

GOLD 1 >80
GOLD 2 50-79%
GOLD 3 30-49%
GOLD 4 <30%

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2 COPD scoring systems used for symptom assessment (higher = worse sx)

mMRC dyspnea scale for breathlessness: score 0-4

COPD Assessment Test (CAT) for range of symptoms: score 0-40

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increase in respiratory symptoms causing hospitalization or increasing risk of death

COPD exacerbation

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focuses on symptoms assessment and risk of exacerbations for components to drive treatment

combined assessment of COPD

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group if >=2 mod exacerbations or >=1 leading to hospital admission, regardless of CAT and mMRC scores

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group of 0 or 1 mod exacerbation (no hospital), CAT <10, mMRC 0-1

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group of 0 or 1 mod exacerbation (no hospital), CAT >=10, mMRC >=2

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non-pharm COPD management includes

smoking cessation
vaccination - flu pneumo
inhaler technique and adherence

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treatment of COPD is meant to

decrease symptoms and prevent hospitalizations/exacerbations

first line treatment for all COPD patients

bronchodilators SABA or SAMA can be used PRN in all patients on long-acting bronchodilator

when are ICS recommended in COPD

eosinophil count >= 300 cell/u

when are ICS NOT recommended in COPD

lower eosinophil count <100 cells/uL as there is no demonstrated benefit

initial treatment if group A

bronchodilator SAMA PRN, SABA PRN, LAMA or LABA

initial treatment if group B

LAMA + LABA

initial treatment if group E

LAMA + LABA consider + ICS if eos >300

if COPD is poorly controlled on therapy, what do you do when PRIMARY SYMPTOM IS DYSPNEA

LAMA OR LABA --> LAMA + LABA --> then switch inhalers, reassess other cause

if COPD is poorly controlled on therapy, what do you do when PRIMARY SYMPTOM IS EXACERBATIONS

LAMA OR LABA --> LAMA + LABA (+ ICS based on eos) if LAMA + LABA, can add ICS following if eos >100 last step - roflumilast or azithromycin

when should antibiotics be used for COPD exacerbation

sputum purulence with increased sputum volume dyspnea mechanical ventilation

cause bronchodilation by blocking acetylcholine

muscarinic antagonists

short acting muscarinic antagonist

ipratropium bromide

brand name of ipratropium bromide

Atrovent HFA

dosing of ipratropium bromide (Atrovent)

2 inh Q4-6H PRN

brand name of ipratropium bromide + albuterol

Combivent Respimat

dosing of ipratropium bromide + albuterol (COmbivent)

1 inh Q4-6H PRN

LAMA example

tiotropium glycopyrrolate, umeclidinium

brand name of tiotropium

Spiriva Handihaler, Spiriva Respimat

brand name of tiotropium + olodaterol

Stiolto Respimat

dosing of Spiriva handihaler DPI (tiotropium)

inhale 1 capsule daily (Requires 2 puffs)

dosing of Spiriva and Stiolto respimat

MDI 2 inhalations daily

brand name of glycopyrrolate / formoterol / budesonide

Breztri Aerosphere

generics in breztri

glycopyrrolate / formoterol / budesonide

what type of inhaler is breztri

MDI

brand name of umeclidinium + vilanterol

Anoro Ellipta

generics in Anoro Ellipta

umeclidinium + vilanterol

brand name of umeclidinium / vilanterol / fluticasone

Trelegy Ellipta

generics in Trelegy

umeclidinium / vilanterol / fluticasone

what type of inhaler is Anoro and Trelegy

DPI

what type of inhalers are the Pressairs

DPI

Pressairs are DPIs with an indicator that turns ___ if dose was properly inhaled

red to green

AE of SAMAs and LAMAs

dry mouth

monitoring for SAMAs and LAMAs, and LABAs

smoking status, COPD questionnaires, annual spirometry

HandiHalers are DPIs that come with

capsule to go in device - do not swallow

bind beta 2 to cause relaxation of bronchial smooth muscle andbronchodilation

beta 2 agonists monotherapy ONLY IN COPD

brand name of fluticasone + salmeterol

Advair diskus

brand name of fluticasone + vilanterol

Breo Ellipta

Symbicort, Breyna, and Stiolto are what type of inhaler

MDI

what type of inhaler is Advair, Pressair, Breo, Anoro, Trelegy

DPI

AEs of LABAs

nervousness, tremor, tachycardia, palpitations, hyperglycemia, low K

counseling for ICS meds

rinse and spit to prevent thrush

PDE4 inhibitor that increases cAMP causing reduction in lung inflammation

roflumilast

warning of roflumilast

weight loss

AE of roflumilast

diarrhea

counseling for Atrovent HFA (MDI - ipratropium)

do not shake close eyes breath in slow and deep hold breath for 10 seconds cap that goes on and off

how to clean Atrovent HFA (MDI - ipratropium)

rinse mouthpiece at least weekly

counseling for respimat products (Combivent, Striverdi, Stiolto, Spiriva)

TOP - turn open press** turn clear base, open cap and breathe out, press the dose button hold breath up to 10 seconds

cleaning of for respimat products (MDI - Combivent, Striverdi, Stiolto, Spiriva)

damp cloth or tissue weekly

how to use spirivia handihaler (DPI - tiotropium)

open by pressing green button and lifting cap, open mouthpiece remove capsule and place into chamber press green button once until flat breathe out with head turned away hold horizontal, breath deep and full will hear rattle inhale twice from each capsule

how to use Pressair DPI inhalers

check red to green in control window breathe in quickly and deeply until you hear a click check window has turned red

how to use Ellipta products

do not block air vent breathe through mouthpiece rinse mouth and spit

COPD Flashcards

(75 cards)