COPD

Question 1

Characteristics of COPD

Answer 1

Airflow limitation

• Not fully reversible
• Chronic & progressive

Preventable

Treatable

Question 2

COPD Pathophysiology

Answer 2

Reversible: small airways dz, airway inflammation & increased airway resistance

Irreversible: parenchymal destruction, loss of alveolar attachment, decrease in elastic recoil, airway fibrosis

Question 3

Risk Factors for COPD

Answer 3

• Cigarette smoking 85-90%!
• Exposures: env. Tobacco smoke, occupational dusts, chemicals and air pollution
• Host factors: genetics predisposition (AAT deficiency), airway hyper-responsive, impaired lung growth

Question 4

COPD vs Asthma: cells

Answer 4

COPD: neutrophils, large increase in macrophages

Asthma: eosiniophils, small increase in macrophages, activation of mast cells

Question 5

COPD vs Asthma​: mediators

Answer 5

COPD: LTB4, IL8, TNF-a

Asthma: LTD4, IL4, IL5

Question 6

COPD vs Asthma: Consequences

Answer 6

COPD: parenchymal destruction, mucus metaplasia, glandular enlargement

Asthma: thickening of basement membrane; mucus metaplasia, glandular enlargement

Question 7

COPD vs Asthma: response to Tx

Answer 7

COPD: Glucocorticoids have variable effect

Asthma: Glucocorticoids inhibit inflammation

Question 8

COPD: symptoms

Answer 8

Chronic cough
Sputum production

Dyspnea

Question 9

COPD: PE

Answer 9

• Cyanosis of mucosal membranes
• Barrel chest
• ↑resting respiratory rate
• Shallow breathing
• Pursed lips during expiration
• Use of accessory respiratory muscles

Question 10

COPD: Diagnostic Tests

Answer 10

• Spirometry with reversibility testing
• Radiograph of chest
• Arterial blood gas (not routine)

Question 11

COPD Prevention

Answer 11

• Smoking cessation
• Vaccination
  
  • Influenza
    
    • ↓ illness causing hospitalizations in COPD
    • ↓ mortality in COPD
• Pneumococcal
  
  • ↓ incidence of community acquired pneumonia in COPD

Question 12

COPD: medication classes

Answer 12

• SABA
• SAA – short acting antichol
• LABA
• LA-anticholinergics
• ICS
• Phosphodiesterase Inhibitors

Question 13

COPD: SABAs

Answer 13

• Albuterol
• Levalbuterol
• Pirbuterol

Question 14

COPD: SAAs

Answer 14

Ipratropium

Question 15

COPD: LABAs

Answer 15

• Salmeterol
• Formeterol
• Arformeterol
• Indacaterol

Question 16

COPD: LA-anticholinergics

Answer 16

Tiotropium

Aclidinium

Question 17

COPD: ICS

Answer 17

• Beclomethasone
• Fluticasone
• Mometasone
• Budesonide
• Ciclesonide

Question 18

COPD: Phosphodiesterase Inhibitors

Answer 18

Roflumilast (Daliresp)

Question 19

Roflumilast (Daliresp): MOA

Answer 19

Selective phosphodiesterase-4 (PDE-4) inhibitor

Question 20

Roflumilast (Daliresp)​: Dosing

Answer 20

500 mcg orally once daily [$300/month]

(Phosphodiesterase Inhibitors)

Question 21

Roflumilast (Daliresp): Adjunctive therapy

Answer 21

for severe COPD (refractory cases)

• Pre and Post bronchodilator FEV1 greater in roflumilast group vs. placebo
• Reduces exacerbations in patients with FEV1 < 50, chronic bronchitis,
• history of frequent exacerbations

(Phosphodiesterase Inhibitors)

Question 22

Roflumilast (Daliresp): Adverse Effects

Answer 22

Gastrointestinal:

• 9.5% suffered from diarrhea vs. 2.7% in the placebo group.
• 4.7% had nausea compared 1.4% who received placebo.

Psychiatric

• Insomnia, anxiety, and depression
• Suicidal ideation
• Contraindicated in patients with moderate to severe hepatic impairment (CP Class B or C)

(Phosphodiesterase Inhibitors)