Copd

Front 1

COPD- end result is physio defect in which there is obstruction to airflow that causes ___ of the ____ air flow.
Airflow limitation is usually ____
There is remodeling of small airways with loss of ___ attachments which ___ airway elasticity

Back 1

1. slowing down
2. expiratory
3. progressive

4. alveolar attachments
5. loss of alveolar attachments leads to reduction in airway elasticity

Front 2

Three main diseases that are included in the COPD classification

Back 2

1. emphysema
2. chronic bronchitis
3. bronchiectasis

Front 3

Emphysema--
Chronic bronchitis-
Bronchiectasis-

Back 3

Emphysema- slowed airflow b/c of tissue destruction w/ abnormal permanent enlargement of airspaces distal to terminal bronchioles and destruction of alveolar walls
Chronic bronchitis- reason for obstruction is hypertrophy of mucus glands and overproduction of mucus in the bronchial tree
- Bronchiectasis- infection/inflammation related chronic disease process

Front 4

What is the most important non pharm management of COPD?

Back 4

SMOKING cessation-- slows progression of COPD

Front 5

Mild COPD-

Back 5

1. FEv1/ FVC less than 0.7, with FEV1 greater than or equal to 80% predicted

Front 6

Moderate COPD

Back 6

50%< FEV1<80% predicted

Front 7

Severe COPD

Back 7

30%<FEV1<50% predicted

Front 8

Very severe COPD

Back 8

FEV1< 30% predicted or less than 50% predicted + resp failure

Front 9

Mild COPD requires ___ while moderate requires ____ . Severe COPD requires ____. Very severe COPD requires __ if chronic resp failure and consider surgical options

Back 9

1. albuterol PRN
2. regular tx with long acting bronchodilator
3. Add ICS
4. long term O2

Front 10

Which meds used for COPD help to modify the long term decline in lung function that is the hallmark of the disease?

Back 10

1. NONE, only symptomatic tx and to decrease further complications

Front 11

IS it better to have SABA alone?

Back 11

No, better to combine SABA with anticholinergic

Front 12

- SABA used in what class of COPD?

Back 12

- used by itself for mild disease, and used in combo w/ all other classes
- DOC for acute exacerbations

Front 13

What are the Long acting bronchodilators used in COPD?

Back 13

- anticholinergics- tiotropium
- beta 2 agonists- fomoterol, salmeterol

Front 14

Anticholinergic drgs (tiotropim)-MOA

Back 14

- Cholinergic tone is the primary reversible component of COPD
- Normal airway have imperceptible degree of vagal cholinergic tone
- Airways are narrowed in COPD so vagal cholinergic tone has greater effect on airway resistance
- Anticholinergic drugs which will act as muscarinic receptor antag and block the ach induced bronchoconstriction
- Anticholinergics may also reduce mucus hypersecretion

Front 15

Anticholinergic drugs- AE
Atropine-
Ipratropim and tiotropium-

Back 15

Atropine- tertiary struc which will cross mucosa of oral and resp tract-- leading to systemic SC- blurred vision, urinary retention, tachycardia
- ipratropium and tiotropim have quat structure that is NOT systemically absorbed- so no systemic SE, some dry mouth

Front 16

Triotropium- Use

Back 16

- some say better than LABA, only for maintenance therapy, dry mouth

Front 17

Beta agonists- use

Back 17

- promote sm relaxation
- increase FEV1
- long acting-- duration of action- greater than 12 hrs
- short acting- 4-6 hrs

Front 18

LABA- use in COPD
- what is limitation of combivent?

Back 18

- 2nd line drugs after irpatropoium for pts with COPD
- often add on- combivent- combo with alubterol limits max dose

Front 19

Theophylline- use

Back 19

- add on for pts who have not responded well to LABA and ipratropium, not routinely used due to toxicity
- tx only continued if after 2-4 wk trial see imrpovement

Front 20

ICS- Use, AE

Back 20

- No consistent effect on decreasing inflammation
- NOT rec as 1st line therapy
- In patients with severe COPD (FEV1 <50% -stage 3&4) who experience frequent exacerbations while receiving one or more long-acting bronchodilators, addition of an ICS may reduce the number of exacerbations requiring systemic steroids or antibiotics
AE: increase risk of pneumonia

Front 21

Oral Corticosteroids- USe

Back 21

- short course of “burst” oral steroids may be useful in managing acute COPD exacerbation severe enough to warrant hospitalization
- Chronic treatment with systemic glucocorticosteroids should be avoided because of an unfavorable benefit-to-risk ratio (Evidence A)

Front 22

What vaccinations should be given to reduce exacerbations?

Back 22

Influenza, pneumonia