COPD

Question 1

What is COPD?

Answer 1

• Respiratory condition that causes airwau obstruction from lungs

Question 2

What are some of the risk factors that could lead to COPD?

Answer 2

• TOBACCO SMOKE
• Smoke from fires or coal
• Marijuana
• Work pollutions

Question 3

What is the difference between Emphysema and Bronchitis?

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Answer 3

• Emphysema: destruction of the alveloi in the lungs
• Bronchitis: Inflammation and narrowing of the bronchials

Question 4

What are some of the symptoms that someone with COPD may have?

Answer 4

• SOB
• Cough
• Sputum Production
• Wheezing

Risk factors of smoking

Question 5

What is one test that helps confirm COPD?

Answer 5

• Spirometry with FEV1/FVC < 0.70

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Question 6

What four components must be followe to assess COPD?

Answer 6

• Degree of airflow
• Symptom assessment
• Risk of Exacerbation
• Presence of comorbidities

Question 7

What is the the degree of airflow limitation in COPD assessment?

“GOLD”

Answer 7

• GOLD 1 - MILD - FEV1 > 80%
• GOLD 2 - MODERATE - FEV1 50 -79%
• GOLD 3 -SEVERE - FEV1 30 - 49%
• GOLD 4 - VERY SEVERE - FEV1 < 30%

Question 8

What is the way that we assess symptoms for COPD?

Answer 8

• mMRC: assessing breathlessness (0-4 scale)
• CAT: assessing range of symptoms (0-40 scale)

Question 9

What is a COPD exacerbation?

Answer 9

• increase in respiratory symptoms that worsens airflow
• Hospitalization = increased risk of death

Question 10

What are some of the comorbities associated with COPD?

Answer 10

• CV disease
• Osteoporsis
• Diabetes
• Depression
• Anxiety
• Respiratory infections
• Lung cancer

Question 11

With the combined assessment (Group A, B, E); what does each group mean?

Answer 11

• A: CAT < 10; mMRC 0 - 1; Exacerbations 0 - 1 (no hospital)
• B: CAT > 10; mMRC > 2; Exacerbations 0 - 1 (no hospital)
• E: 2 or more exacerbations with 1 leading to hospital

Question 12

What are some non drug treatment options for COPD?

Answer 12

• Smoking cessation (slows progression of COPD)
• Vaccinations (flu & pneumonia)
• Inhaler technique and adherence

Question 13

What are some of the drug treatments for COPD?

Answer 13

• Bronchodilators are 1st line (SAMA or SABA; LAMA or LABA)
• ICS ONLY when the eosinophil count > 300
• Combo (LAMA + LABA + ICS) when needed
• Roflumilast and Azithromycin in severe cases

Question 14

What is the intital treatment for someone in group A?

Answer 14

• Bronchodilator (SAMA PRN, SABA PRN, LAMA or LABA)

Question 15

What is the initial treatment for someone in group B?

Answer 15

• LAMA + LABA

Question 16

What is the initial treatment for someone in Group E?

Answer 16

• LAMA + LABA
• LAMA + LABA + ICS (only when eos > 300)

Question 17

What is the MOA for the muscarinic antagonist/anticholinergics?

Answer 17

• Causes bronchodilation by blocking acetylcholine at M3 receptors in smooth muscle

Question 18

What are the SAMAs that are used for COPD?

Answer 18

• Ipratropim Bromide (Atrovent HFA - 2 puffs Q4-6H)
• + Albuterol (Combivent Respimat - 1 puff Q4-6H)

Question 19

What are the LAMAs that are used for COPD?

Answer 19

• Tiotropium (Spiriva Handihaler - Inhale 1 cap daily)
• Tiotropium (Spiriva Respimat - 2 puff daily)
• Glycopyrrolate + Formoterol/budesonide (Breztri)
• Umeclidinum + Vilanterol/fluticasone (Trelegy)

Question 20

What are some side effects for the muscarinic antagonist/anticholinergics?

Answer 20

• Dry Mouth
• Upper Respiratory Tract Infections
• Cough
• Bitter Taste

Question 21

What are some additional notes for the Muscarinic Antagonists/Anticholinergics?

Answer 21

• Handihaler: DO NOT swallow capsule
• ICS containing: rinse out mouth to avoid trush

Question 22

what is the MOA for the Beta-2 agonist?

Answer 22

• bind to beta-2 receptors in the lung, causing relaxation of bronchial smooth muscle and bronchodilation

LABAs can be monotherapy for COPD, not asthma

Question 23

What are some LABAs that are used for COPD?

Answer 23

• Salmeterol (Serevent Diskus) + Fluticasone (Adviar Diskus)
• Formoterol + Budesonide (Symbicort)
• Vilanterol + Fluticasone (Breo)

Formoterol + Budesonide + Glycopyrrolate (Breztri)
Vilanterol + Fluticasone + Umeclidinum (Trelegy)

Question 24

What are some side effects for the LABAs used for COPD?

Answer 24

• Nervousness
• Tremor
• Tachycardia
• Palpitations
• Hyperglycemia
• Decreased Potassium

Question 25

What are some **additional notes** for the **LABAs** used for **COPD**?

Answer 25

- ICS products: rinse out mouth to avoid thrush

Question 26

What is the **MOA** for **Roflumilast**?

Answer 26

- PDE-4 Inhibitor that reduces the lung inflammation (last line)

Question 27

What are some warnings for **roflumilast**?

Answer 27

- Wieght loss

Question 28

What are some **side effects** for **Roflumilast**?

Answer 28

- Diarrhea - Nausea - Decreased Appetite (weight loss warnings)

Question 29

What is the **proper way** to used a **MDI (HFA) inhaler**

Answer 29

- Remove the dust cap - Prime my spraying **2 times** away from face (do not have to prime Atrovent) - Breathe out fully - Place mouthpiece in mouth, wrapping lips around it - Close eyes and while breathing in **SLOW & DEEP** press top of canister - Hold breath for **10 secs** - If needing another dose repeat

Question 30

What is the **proper way** to used a **MDI (Respimat) inhaler**? ## Footnote **"TOP"**

Answer 30

- **T**urn the blear base (should hear "click") - **O**pen the cap, breathe out and close your lips around the mouthpiece - **P**ress the dose release button and inhale (hold for **10 Secs**)

Question 31

What is the **proper way** to used a **DPI (Handihaler) Inhaler**?

Answer 31

- Open by pressing green button then **open** mouthpiece - Place **capsule** inside the chamber; **close** mouthpiece - Press green button to pierce capsule - Breathe out fully - In a horizontal position, place mouthpiece inside mouth (lips tight around) and breathe **FULL & DEEP** (should hear rattle) - To get full dose inhale **twice**