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73 Cards in this Set
- Front
- Back
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What is difference in trigger for asthma and copd?
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COPD is caused by a Noxious agent while Asthma is caused by a sensitizing agent
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What immune cells are involved in COPD?
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CD8+ T-lymphocytes, Macrophages, Neutrophils
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What immune cells are involved in Asthma?
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CD4+ T-lymphocytes, eosinophils
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Is the airflow limitation in asthma reversible?
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yes
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Is the airflow limitation in COPD reversible?
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no, the disease is progressive
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What are the treatment goals of COPD? (GOLD)
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Prevent disease progression, relieve symptoms, improve exercise tolerance, improve health status, prevent and treat complications, prevent and treat exacerbations, reduce overall morbidity and mortality, achieve maximal pharmacotherapeutic benefit with minimal side effects
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What are the indicators for diagnosis of COPD?
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pt over 40 with dyspnea, chronic cough (first to develop usually), chronic sputum production, history of exposure to risk factors
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What are the risk factors for COPD?
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Exposure to tobacco smoke, occupational dust and chemicals, smoke from home cooking or fuel, infections, socio-economic status, male gender, aging population, indoor and outdoor air pollution
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What are the spirometry results to confirm COPD?
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Post-bronchodilator FEV1 < 80% predicted, FEV1/FVC <70%
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What are the characteristics of mild COPD?
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FEV1/FVC <70%, FEV1>= 80 predicted, With or without chronic symptoms (cough, sputum production)
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What are the characteristics of moderate COPD?
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FEV1/FVC < 70%; FEV1 50-79% predicted, SOB typically developing on exertion
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What are the characteristics of severe COPD?
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FEV1/FVC <70%, FEV1 30-49% predicted, greater SOB, decrease exercise capacity, fatigue, and repeated exacerbations which almost always have an effect on pts QOL
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What are the characteristics of very severe COPD?
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FEV1/FVC < 70%; FEV1 < 30% predicted or FEV1 < 50% predicted plus respiratory failure
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What is the single most effective and cost effective intervention in COPD?
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smoking cessation
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What are the nonpharmacologic therapies for COPD?
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Education (information and advice about reducing risk factors), exercise training programs (improve exercise tolerance and symptoms of dyspnea and fatigue), long-term oxygen (> 15 h/day) in pts with chronic respiratory failure has been shown to increase survival, vaccinations (Flu and pneu)
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What is the place in therapy of SABAs in COPD?
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Quick relief during acute exacerbations, can be given as maintenance therapy (usually with ipratropium) in pts with stage I
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What is the trade name for Ipratropium?
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Atrovent (MDI) (short acting)
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What is the trade name for tiotropium?
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Spiriva (DPI) (long acting)
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What is the place in therapy of Ipratropium in COPD?
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First line therapy for COPD, standard maintenance in Stage I
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What is the MOA of tiotropium?
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Selective inhibitor of muscarinic M1 and M3 receptors that promote bronchoconstriction
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What is the duration of action of tiotropium?
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24-72 h
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What is the frequency of use of tiotropium?
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QD
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In the trial of Ipratropium vs tiotropium for COPD (Vincken et al), what was the results?
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Tiotropium was superior to ipratropium in terms of effect on FEV1 over a year and decreased use of rescue inhaler
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What were the results of the UPLIFT trial?
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Showed tiotropium use was associated with improvement in lung function, QOL, and exacerbations during a 4 yr period, but did not significantly reduce the rate of decline in FEV1
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Between ipratropium and tiotropium, which causes dry mouth more often?
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tiotropium
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What is the trade name for Arformeterol?
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Brovana (long acting)
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What was the result of the Ultra long acting beta 2 agonist trial (korn et al)?
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Indacaterol was superior to salmeterol in all end points leading to fewer puffs/day of rescue inhaler and greater # of days without using rescue
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What is the onset of action for albuterol?
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5 mins
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What is the onset of action for salmeterol?
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20 min
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What is the onset of action for formoterol?
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5 min
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What is the duration of action for albuterol?
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4 to 8 h
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WHat is the duration of action for salmeterol?
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12 h
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What is the duration of action for foradil?
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12 h
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What is the place in therapy for LABAs in COPD?
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Maintenance treatment of pts with moderate (stage II) to very severe (stage IV) COPD either alone or in combination with other bronchodilators
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According to the CHEST trial, which is better in COPD, tiotropium or salmeterol?
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No difference between the two in incidence of exacerbations or need for SABA
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According to the POET-COPD trial, which is better for COPD, tiotropium or salmeterol?
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Tiotropium shown to be more effective than salmeterol in preventing exacerbations
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What is the place in therapy of Methylxanthines in COPD?
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Effective in COPD, but due to potential toxicity, inhaled bronchodilators are preferred. Additionally lacks anti-inflammatory properties and relatively weak in brochodilating properties
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What route of therapy is preferred in COPD?
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inhaled
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Long acting bronchodilators or short acting are preferred in moderate to very severe COPD (stage 2 through 4)?
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Long acting
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What does GOLD say about combined use of bronchodilators?
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Combining bronchodilators may improve efficacy and decrease the risk of side effects compared to increasing the doses of a single brochodilator. Combination of a beta agonist, an anticholinergic, and/or theophylline may produce additional improvements in lung function and health status
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What are the irreversible causes of airflow limitations in COPD?
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Fibrosis and narrowing of the airways, loss of elastic recoil due to destruction of alveolar walls, destruction of alveolar support that maintains patency of small airways
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What are the reversible causes of airflow limitation in COPD?
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accumulation of inflammatory cells, mucus and plasma exudate in bronchi, smooth muscle contraction in peripheral and central airways, dynamic hyperinflation during exercise
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What is the trade name of beclomethasone dipropionate MDI?
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Qvar
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What is the trade name of budesonide?
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Pulmicort
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What is the trade name of fluticasone MDI?
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Flovent
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What is the trade name of triamcinolone MDI?
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Azmacort
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According to GOLD guidelines is COPD, what is the place in therapy of systemic oral corticosteroids?
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Should be avoided due to "unfavorable benefit to risk ratio"
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What is the trade name for Roflumilast?
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Daliresp
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What is the MOA of Daliresp?
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selectively inhibits PDE-4 (phosphodiesterase 4) leading to accumulation of cAMP
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What are the contraindications in Daliresp?
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moderate to severe hepatic impairment
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What are the side effects of Daliresp?
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Weight loss, diarrhea, neuropsychiatric effects
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What are the drug interactions with Daliresp?
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CYP3a4 inducers,Immunosuppresive agents, Rifampin
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What is the place in therapy of Daliresp?
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add to regular treatment with bronchodilators in pts with Stage III or IV and h/o exacerbations and chronic brochitis
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According to Gold guidelines in COPD, are antitussives recommended?
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no
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According to Gold guidelines in COPD, are antibiotics recommended?
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only in infections
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According to Gold guidelines in COPD, are mucolytics recommended?
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no
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According to Gold guidelines in COPD, are antioxidants recommended?
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no
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According to Gold guidelines in COPD, what two vaccines are recommended?
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flu and pneu
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According to Gold guidelines in COPD, are LTRA recommended?
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no
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According to Gold guidelines in COPD, are Mast cell stabilizers recommended?
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no
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According to Gold guidelines in COPD, what is the treatment in Stage I / mild COPD?
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short acting bronchodilators prn
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According to Gold guidelines in COPD, what is the treatment in Stage II / moderate COPD?
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scheduled long acting bronchodilators + pulmonary rehab
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According to Gold guidelines in COPD,what is the treatment in Stage III / severe COPD?
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Scheduled long acting bronchodilators +pulm rehab + inhaled CS if repeated exacerbations
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According to Gold guidelines in COPD, what is recommended in Stage IV / very severe COPD?
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Scheduled Long acting bronchodilators + pulm rehab + inhaled CS if repeated exacerbations + oxygen
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What are the common causes of COPD exacerbations?
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infection, pollution, unknown
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What are the symptoms in COPD exacerbations?
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increased breathlessness, wheezing, chest tightness, increase in cough, increase in sputum production, change in sputum color, fever
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According to Gold guidelines in COPD, what are the indications for hospital admission?
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marked increase in intensity of symptoms, onset of new physical signs (cyanosis, peripheral edema), failure to respond to initial medical management, significant comorbities, new occurring arrhythmias, older age, insufficient home support
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According to Gold guidelines in COPD, what are the management key points?
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Controlled o2 therapy, bronchodilator therapy, oral systemic CS, possibble Abx, possible noninvasive mechanical ventilation
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What is the cornerstone of hospital COPD exacerbation treatment?
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oxygen therapy. administer and repeat AGN after 30 minutes to ensure satisfactory oxygenation
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According to Gold guidelines in COPD, what is the preferred treatment of exacerbations?
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SABAs. if prompt response does not occur, the addition of an anticholinergic is recommended
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According to Gold guidelines in COPD, how is CS recommended in exacerbations?
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Oral or iv during hospital management. 30-40mg pred x 10 - 14 d. Prolonged treatment does NOT result in greater efficacy
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According to Gold guidelines in COPD, when are Abx recommended?
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exacerbations with increased dyspnea, sputum volume, and sputum purulence (all three) OR sputum purulence increase with increase in dyspnea or sputum volume OR in a mechanically ventilated pt
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What are the discharge criteria for PTS with exacerbations of COPD?
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inhaled b2 agonist therapy is required no more frequently than q 4 h, pt is able to walk across room, pt is able to eat and sleep without frequent dyspnea, pt has been clinically stable for 12-24 h, ABGs have been stable for 12-24 h, follow up and home care have been arranged
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