RESP 18: COPD

Question 1

What is COPD?

Answer 1

heterogeneous lung condition characterized by chronic respiratory symptoms (dyspnea, cough, expectoration and/or exacerbations) due to abnormalities of airways (bronchitis, bronchiolitis) and/or alveoli (emphysema) that cause persistent, often progressive, airflow obstruction

Question 2

What is alpha-1 antitrypsin?

Answer 2

major circulating inhibitor of serine proteases

• < 1% of COPD cases
• in patients < 45 years

Question 3

What are the reversible components of airflow limitation?

Answer 3

• presence of mucus and inflammatory cells and mediators in bronchial secretions
• bronchial smooth muscle contract in peripheral and central airways
• dynamic hyperinflation in exercise

Question 4

What are the irreversible components of airflow limitation?

Answer 4

• 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 5

Tiotropium vs. Salmeterol

Answer 5

• time to first exacerbation increased with tiotropium vs. salmeterol
• decrease risk of moderate exacerbations
• decrease risk of severe exacerbations

Question 6

What is the MOA of SABAs?

Answer 6

stimulates beta-2 adrenergic receptors, increases cAMP, bronchodilation

Question 7

What is the MOA of LABAs?

Answer 7

binds to beta-2 pulmonary receptors, slower to dissociate than SABA

Question 8

What is the MOA of SAMAs?

Answer 8

blocks M2 and M3 receptors

Question 9

What is the MOA of LAMAs?

Answer 9

blocks muscarinic receptors, slower to dissociate than SAMA

Question 10

Inhalers

Weak Hands/Strong Lungs (4)

Answer 10

• turbuhaler
• diskus
• ellipta
• genuair

Question 11

Inhalers

Strong Hands/Strong Lungs (4)

Answer 11

any

Question 12

Inhalers

Weak Hands/Weak Lungs (1)

Answer 12

• genuair

Question 13

Inhalers

Strong Hands/Weak Lungs (5)

Answer 13

• breezhaler
• handihaler
• genuair
• MDI
• respimat

Question 14

What are other treatment options with some evidence? (3)

Answer 14

• acetylcysteine
• azithromycin
• roflumilast

Question 15

What is the MOA of roflumilast?

Answer 15

reduces inflammation by inhibiting breakdown of intracellular cyclic AMP

Question 16

What is a COPD exacerbation?

Answer 16

characterized by dyspnea and/or cough and sputum that worsen over ≤ 14 days which may be accompanied by tachypnea and/or tachycardia, and is often associated with increased local and systemic inflammation caused by airway infection, pollution, or other insult to airway

Question 17

What are the common causes of COPD exacerbations?

Answer 17

• viral URTIs
• infection of tracheobronchial tree

Question 18

How are COPD exacerbations diagnosed?

Answer 18

exclusively based on clinical presentation of patient complaining of acute change of symptoms beyond normal day-to-day variation

Question 19

What are the treatment options for COPD exacerbations?

Answer 19

• oxygen
• bronchodilators – SABA +/- short-acting anticholinergics
• systemic corticosteroids
• antibiotics