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Naplex
COPD - Clinical pearl
| Question | Answer |
|---|---|
| COPD classification | - Group A: CAAT score < 10, mMRC grade 0 or 1 - Group B: CAAT score ≥ 10, mMRC grade ≥ 2 Group E: ≥ 1 moderate or severe exacerbations in the past year |
| Group A initiate treatment | - LAMA or LABA |
| Group B initiate treatment | |
| Group E initiate treatment | |
| SAMA / LAMA side effects | Muscarinic antagonists SEs incl: Dry mouth, cough, bitter taste |
| SABA / LABA side effects | Beta-2 agonists SEs incl: Nervousness, tremor, tachycardia, hyperglycemia, hypokalemia |
| TRUE or FALSE: ICS/LABA is part of COPD treatment regiment | FALSE, ICS/LABA has no role in COPD |
| When is ICS added to LABA + LAMA for COPD treatment | Eosinophils ≥ 300 cells/uL, expect a good response to ICS treatment |
| When is Roflumilast or Azithromycin added to COPD treatment regiment | Exacerbations despite on - LAMA + LABA and Eos < 100 (Roflumilast, a PD-4, prefer for smoker, Azi for non smoker) - AMA + LABA + ICS and Eos >= 100 and < 300 |
| When is Azithromycin added to COPD treatment regiment | Exacerbations despite on LAMA + LABA and Eos < 100 and NON-former smokers (prevent exacerbations) |
| What treatment regiment if pt has Dyspnea despite on Bronchodilators LAMA or LABA | LAMA + LABA |
| What is First Line treatment for COPD | Bronchodilators LAMA or LABA |
| Should ICS be added to Bronchodilators LAMA or LABA if experiences Dyspnea | NO, ICS has no role |
| What inhalers require priming before first use? | MDIs: before first use & after periods of nonuse - HFA: cleaning by rinsing under warm running water & let air dry - no suffix: wipe with a clean, dry cloth - Respimat: Wipe with a damp cloth or tissue weekly |
| TRUE or FALSE: COPD management incl Treatment for smoking cessation | TRUE. Despite COPD symptoms are in under control, smoking cessation should be next step to improve COPD management. Treatment for smoking cessation includes behavioral therapy and pharmacotherapy (eg, varenicline). |
| Which test should be performed to confirm a diagnosis of COPD? | Spirometry. |
| Peak flow | is a respiratory test that uses a handheld device (ie, a peak flow meter) to measure peak expiratory flow rate (how fast air is exhaled). It is primarily used to monitor asthma control. |
| Emphysema directly contributes to airflow obstruction in COPD by | Damages alveoli and impairs gas exchange in the lungs. This leads to a reduction in oxygenation and symptoms such as shortness of breath, wheezing, and fatigue. |
| What inhaler needs Keeping eyes closed during inhalation | Atrovent HFA: MDI w ipratropium, an anticholinergic, as an aerosolized liquid via propellant; closing eyes during inhalation to prevent this medication from entering the eyes and causing anticholinergic effects, like blurred vision or eye pain. |
| What MDIs do require shaking prior use | Unlike suspension-based inhalers, Atrovent HFA is a solution-based formulation that is uniformly distributed, eliminating the need to shake it before use. |
| Pressair devices w a control window that changes from red to green prior to inhalation | DPIs: strong inhalation to deliver med to the lungs. The dose is ready for inhalation when the control window changes from red to green. The user should breathe in quickly and deeply until a click is heard, which indicates the full dose was delivered. |
| Diskus devices (lever) | DPIs: slide the lever until it clicks, which exposes the mouthpiece and reduces the dose counter by one. |
| Ellipta products (open the cover) | DPis: the cover is opened to expose the mouthpiece, which decreases the dose counter by one. |
| HandiHaler (prefilled capsule) | DPIs: prefilled capsule is placed in the chamber and the green button is pressed, piercing the capsule. |
| Respimat (TOP technique) | - Turn the base - Open the cap, close the lips around the mouthpiece, and - Press the dose-release button while inhaling. |
| Long-acting beta-2 agonists (LABAs) SEs | - Tremors - Tachycardia - Palpitations - Nervousness - HyPERglycemia - HyPOkalemia. |
| Diarrhea and weight loss are SEs of | Roflumilast |
| Blurry vision is SEs of | SAMA, LAMA |
| What FEV1/FVC value to confirm a diagnosis of COPD? | FEV1/FVC < 0.7 |
| Post bronchodilator FEV1 increase ≥ 12% and ≥ 200 mL, indicates: | reversibility (also called bronchodilator responsiveness) and is consistent with an asthma diagnosis. |
| Spiriva Respimat (tiotropium) dosing for COPD | 2 inhalations daily |
| When adding dupilumab, mepolizumab to COPD treatment regimen | Pt is on tripple regiment LAMA + LABA + ICS, with Eos ≥ 300, and exacerbation history |
| Administration of Spiriva HandiHaler | - Hold device horizontally - Close lips around the mouthpiece, inhale deeply and fully. Then, they will remove the inhaler and hold their breath - Repeated again (inhaling twice for each capsule), should hear the capsule vibrate during inhalation. |
| Roflumilast safety warnings | weight loss and psychiatric events (eg, mood changes, depression, suicidality), and carries a risk for several adverse effects (eg, diarrhea, nausea, insomnia). |
Created by:
dao.vo11017