COPD (CHRONIC OBSTRUCTIVE PULMONARY DISEASE)

Question 1

Why are Blood eosinophil count important?

Answer 1

predicts the magnitude of the effects of inhaled corticosteroids
<100 -> no effect or little
>300 cells –> more likley to benefit

Question 2

What are the goals for COPD treatment?

Answer 2

Reduce symptoms
- Relieve symptoms
- Improve exercise tolerance
- Improve health status
Reduce risk
- Prevent disease progression
- Prevent and treat exacerbations
- Reduce mortality

Question 3

What CANNOT be a goal of COPD?

Answer 3

lung structure cannot be retained; big difference between asthma and COPD

Question 4

What can you offer for smoking cessation aids?

Answer 4

-Nicotine replacement (gum, lozenge, inhaler, nasal spray, patch)
- Antidepressants (bupropion sustained release, nortriptyline)
- Varenicline (nicotinic acetylcholine receptor partial agonist)

Question 5

What are the key features of Pulmonary rehabilitation?

Answer 5

• Strength & aerobic training
• Weight & nutrition management (decreasing weight will help breathe better)

Question 6

Adverse effects of inhaled corticosteroids

Answer 6

-Oral candidiasis
- Hoarse voice
- Skin bruising
- Pneumonia
- Decreased bone density – conflicting results

Question 7

Oral steriods in COPD

Answer 7

no role in the chronic daily treatment of COPD due to systemic complications

Question 8

When is it strongly favored that ICS should be used?

Answer 8

-History of hospitalization(s) for exacerbations of COPD (despite LABA therapy)
-≥ 2 moderate exacerbations of COPD per year (despite LABA therapy)
-Blood eosinophils ≥ 300 cells/µL
-History of, or concomitant asthma

Question 9

When is it normal favored that ICS should be used?

Answer 9

-1 moderate exacerbation of COPD per year (despite LABA therapy)
-Blood eosinophils ≥ 100 to < 300 cells/µL

Question 10

When is it against favored that ICS should be used?

Answer 10

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

Question 11

Roflumilast MOA, Effects, Brand name, Adverse effects

Answer 11

Daliresp®
* Phosphodiesterase-4 inhibitor: Reduces inflammation through inhibition of the breakdown of cAMP, No bronchodilator activity
- Adverse Events: Nausea, Reduced appetite, Abdominal pain, Diarrhea, Sleep disturbances, Headache,Weight loss

Question 11

Ensifentrine MOA, Effects, Brand name, Adverse effects

Answer 11

Ohtuvayre®

Mechanism: dual inhibitor of phosphodiesterase 3 and 4

Adverse effects: Hypertension, Diarrhea, Back pain, Depression, suicidal tendencies

Question 12

Dupilumab MOA, Effects, Brand name, Adverse effects

Answer 12

Dupixent®

Mechanism: inhibitor of IL-4 and IL-13

• Reduced exacerbations and improved lung function and health status in patients with one or more severe exacerbations in the past year and eosinophils ≥300 cells/µL despite treatment with LABA + LAMA + ICS

Question 13

What is initial pharmacological treatment for Group A

Answer 13

A bronchodilator (LABA or LAMA)

Question 14

What is initial pharmacological treatment for Group B

Answer 14

LABA + LAMA (combo)

Question 15

What is initial pharmacological treatment for Group E

Answer 15

LABA + LAMA + ICS (if >300 esonophil)

Question 16

Acute Exacerbations of COPD Definition

Answer 16

Defined as an event characterized by increased dyspnea and/or cough and sputum that worsens in < 14 days which may be accompanied by tachypnea and/or tachycardia and is often associated with increased local and systemic inflammation caused by infection, pollution, or other insult to the airways

Question 17

Acute Exacerbations of COPD
Classification

Answer 17

Mild- treat with SABD only
Moderate- SABD + oral corticosteroid +- antibiotics
Severe- requires hospitalization

Question 18

What are the causes of exacerbations?

Answer 18

Infection of the tracheobronchial tree (bacterial or viral)
Air pollution

Question 19

What are the symptoms of exacerbations?

Answer 19

• Increased sputum volume
• Acutely worsening dyspnea
• Chest tightness
• Presence of purulent sputum
• Increased need for bronchodilators
• Malaise, fatigue
• Decreased exercise tolerance

Question 20

What are the Physical examination results of exacerbations?

Answer 20

Fever
* Wheezing, decreased breath sounds
* Signs of respiratory failure:
- Respiratory rate > 30 breaths per minute, Increased pCO2, hypoxemia,

Question 21

What are the diagnostic tests for exacerbations?

Answer 21

• Pulse oximetry
• Blood tests: Complete blood count, serum electrolytes
• Sputum sample for Gram stain and culture
• Chest radiograph to evaluate for new infiltrates

Question 22

When do you give antibiotics to exacerbation patients?

Answer 22

Give if 3 cardinal symptoms
- Increase in dyspnea
- Increase in sputum volume
- Increase in sputum purulence

with sputum purulence + one ther symptom u can also give

Question 23

Oxygen therapy

Answer 23

A key component of hospital treatment of exacerbations
* Goal is to improve hypoxemia to a target saturation of 88 – 92%
* Ventilatory support using noninvasive technique for critically ill pts

Question 24

Steroid use in exacerbations

Answer 24

Shortens recovery time and improve lung function FEV1) * Improve oxygenation, and reduce risk of early relapse, treatment failure, and length of hospitalization

Question 25

What is COPD

Answer 25

Chronic obstructive pulmonary disease (COPD) is heterogeneous lung condition characterized by chronic respiratory symptoms (dyspnea, cough, sputum production and/or exacerbations) due to abnormalities of the airways (bronchitis, bronchiolitis) and/or alveoli (emphysema) that cause persistent, often progressive, airflow obstruction

Question 26

What are the causes of airflow limitations?

Answer 26

small airways disease (obstructive bronchiolitis) and parenchymal destruction (emphysema)

Question 27

When can airflow limitations be reversible?

Answer 27

-Presence of mucus and inflammatory cells and mediators in bronchial secretions - Bronchial smooth muscle contraction in peripheral and central airways - Dynamic hyperinflation during exercise

Question 28

When can airflow limitations be irreversible?

Answer 28

- Fibrosis and narrowing of airways - Reduced elastic recoil with loss of alveolar surface area - Destruction of alveolar support with reduced patency of small airways

Question 29

What are the risk factors to COPD?

Answer 29

-Exposure to particles - (smoking, tobacco, dust, chemicals, pollution) -Host factors(age, gender, genetic, Asthma/bronchial hyperreactivity, Impaired lung growth)

Question 30

What is the genetic predisposition that is a risk factor for COPD?

Answer 30

alpha-1 antitrypsin deficiency

Question 31

Clinical Indicators for Considering a Diagnosis of COPD

Answer 31

Dyspnea, Recurrent wheeze, Chronic cough, Recurrent respiratory tract infections, history, physical exams

Question 32

Physical examination of COPD

Answer 32

its rarely diagnostic, the physical signs are not present until significant impairment of lung function has occured

Question 33

How can you diagnosis COPD?

Answer 33

Post-bronchodilator spirometry and measure FVC and FEV; FEV1/FVC<0.7 * 10-15 minutes after SABA; 30-45 minutes after SAMA or SABA/SAMA * NOTE – reversibility testing is no longer recommended

Question 34

Classification of severity of airflow limitation (GOLD )

Answer 34

* GOLD 1: Mild – FEV1 ≥ 80% predicted * GOLD 2: Moderate – 50% ≤ FEV1 < 80% predicted * GOLD 3: Severe – 30% ≤ FEV1 < 50% predicted * GOLD 4: Very Severe – FEV1 < 30% predicted