COPD

Question 1

risk factors for COPD

Answer 1

• smoking (85-90% of COPDers)
• inhaled chemicals
• alpha 1 antitrypsin deficiency

Question 2

diagnosing COPD

Answer 2

• spirometry: post bronchodilator FEV1/FVC <0.7
• consider CXR to exclude other diagnoses
• alpha1 antitrypsin serum level if age <65 or <20 pack year history

Question 3

acute exacerbation of COPD definition and causes

Answer 3

• > 48 hours worsening of dyspnea, cough, sputum volume or purulence
• causes: infection (50%), CHF, PE, MI, anemia, irritants

Question 4

acute exacerbation of COPD management

Answer 4

• SABA (Ventolin) + LAMA (spiriva)
• mod to severe: Add 30-50mg pred daily × 5d
• consider antibiotics for increased purulence:
• • simple (no risk factors): amox OR doxy OR septra OR azithro OR tetracycline

– complicated : amox-clav OR levo OR moxiflox

**risk factors for complicated AECOPD: FEV1< 50% predicted, 4 or more exacerbations / year, cardiac disease

Question 5

non-pharm COPD management

Answer 5

• smoking cessation
• exercise
• written action plan
• review puffer technique and patient education
• pulmonary rehab
• vaccines: annual flu, pneumococcal

Question 6

pharm COPD management

Answer 6

• mild : SAMA prn OR SABA prn OR combination SABA + SAMA
• moderate : LAMA and SABA prn OR LABA and SABA prn
• severe : LAMA and LABA and SABA prn
• severe : LAMA and LABA and ICS and SABA prn

Question 7

COPD management depends on…

Answer 7

• PEF % predicted
• exacerbations
• exacerbations requiring hospitalization
• function: physical activity, energy levels