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CC Jan 2018 Chronic Obstructive Pulmonary Disease

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echoecho's version from 2018-04-23 03:24

Section

Question Answer
COPD is now the _____ leading cause of death in the US?Third
Define COPD?It is a chronic lung disease characterized by airflow limitations that is not fully reversible
How is diagnosis of COPD made?With spirometry (ratio of forced expiration volume in 1 second (FEV1) to forced vital capacity (FVC) of < 70%
Up to ___ to ___% of cases of COPD are caused by smoking cigarettes?80, 90
*** Is screening asymptomatic at-risk puts for COPD currently recommended by the USPSTF?No
The first part of COPD severity assessment is based upon the results of what?Spirometry
List the findings of spirometry to assess COPD severity as to GOLD disease classification?1) MILD = NIH classification (mild). Postbronchodilator FEV1/FVC ratio = < 0.7. Postbronchodilator FEV1% of predicted > 80% 2) MODERATE = NIH classification (moderate). Postbronchodilator FEV1/FVC ratio < 0.7. Post bronchodilator FEV1% of predicted is 50-79%. 3)SEVERE = NIH classification (severe). Postbronchodiltor FEV1/FVC < 0.7. Postbronchodilator FEV1% of predicted is 30-49%. 4) VERY SEVERE = NIH classification (very severe). Postbronchodilator FEV1/FVC < 0.7. Postbronchodilator FEV1% of predicted <30%
After spirometry, what is the next step? Symptom assessment should be done using a validated questionnaire like modified Medical Research Council (mMRC) or the COPD Assessment test (CAT)
Regarding the Modified Medical Research Council Scale for COPD, attach the score to the description?1) Not troubled by breathlessness except with strenuous exercise = 0. 2) shortness on reath when hurrying on a level surface or walking up a slight hill = 1. 3) walks slower than people of the same age on a level surface because of breathlessness OR has to stop for breath when walking at their own pace on a level surface = 2. 3) stops for breath after walking about 100 meters OR after a few minutes on a level surface = 3. 4) too breathless to leave the house OR breathless when dressing or undressing.
Regarding the CAT score (COPD Assessment Test), how is it scored?Asks he patients to rate 8 symptoms on a 5 point scale with anchors on either end (1 being the best and 5 being the worst)
List the anchor questions for the CAT (COPD assessment test)?1) I never cough vs. I cough all the time. 2) I have no mucus in my chest at all vs. My chest is full of mucus. 3) My chest does not feel tight at all vs. My chest feels very tight. 4) When I walk up a hill or one flight of stairs I am breathless vs. When I walk up a hill or one flight of stairs I am very breathless 5) I am not limited doing any activities at home vs. I am very limited doing activities at home. 6) I am confident leaving my home despite my lung condition vs. I am not confident leaving my home because of my lung condition. 7) I sleep soundly vs. I don't sleep soundly because of my lung condition. 8) I have lots of energy vs. I have no energy at all
Finally, what is done next after the CAT or mMRC score?A risk group is assigned based upon the spirometry results, the number of COPD exacerbation per year and the mMRC or CAT scores. When selecting risk group,t he highest score for either the mMRC or the CAT should be used.
Treatment options for COPD can be matched to the ____ risk groups A, B, C, D ? GOLD
List the GOLD combined assessment for COPD?1) GOLD RISK GROUP A = GOLD spirometry classification (1 or 2). Exacerbation/year (< 1). mMRC score (0-1). CAT score (< 10). This risk group is low risk with few symptoms. 2) GOLD RISK GROUP B = Gold spirometry classification (1 or 2). Exacerbation/year (< 1). MMRC score (> 2). CAT score (> 10). This risk group is low risk with more symptoms. 3) GOLD RISK GROUP C = GOLD spirometry classification (3 or 4). Exacerbation/year (> 2). MMRC score (0-1). CAT score (< 10).. This risk group is high risk with few symptoms. 4) GOLD RISK GROUP D = GOLD spirometry classification 3 or 4. Exacerbation/year (> 2). MMRC score (> 2). CAT score (> 10). This risk group is high risk, with more symptoms
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BETA-2 AGONIST
Question Answer
Short-acting beta-2 agonists (SABA), a mainstay of symptomatic treatment for patients with ______, are also used for symptomatic relief in patients that have ______?asthma, COPD
Activation of beta-2 receptors in the lung produces ________of bronchial smooth muscle and _______?relaxation; bronchodilator
Why do patients prefer the use of SABA for symptomatic relief over short-acting inhaled anticholinergic medications?SABA has a quicker onset of action
*** Although they reduce symptoms of breathlessness and improve FEV1 in patients with stable disease, beta-2 agonists do not improve ________ tolerance?exercise
Does long-acting beta-2 agonists (LABA) improve breathlessness when used regularly?no
Unlike asthma, the solitary use of LABA for COPD has not been associated with an increase of mortality, true or false?true
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ANTICHOLINERGICS:
Question Answer
The short-acting anticholinergic ipratropium (Atrovent), unlike SABA, has been shown to improve ______ tolerance and _____ quality in patients with COPD?exercise; sleep
It also increases FEV1, true or false?true
What is the major drawback to ipratropium?the dosing, typically 2-3 inhalations 3-4 times per day
Use of the long-acting tiotropium has been assoc'd with fewer exacerbation than ipratropium, but the number need to treat (NNT) is _____ for an entire year to prevent 1 exacerbation?9
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COMBINATION BETA-2 AGONISTS / ANTICHOLINERGICS
Question Answer
For patients requiring more than one bronchodilator, what is available?combination product of ipratropium and albuterol (Combivent)
When compared to Albuterol alone, the combination product produces more improvement in what?wheezing, SOB, and FEV1
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We're these findings found when other combinations of beta-2 agonists and anticholinergics were used
INHALED CORTICOSTEROIDS
Question Answer
Unlike asthma, the use of inhaled corticosteroids in COPD is usually reserved for what type of patien?moderate or severe disease in patients who are symptomatic despite anticholinergic and beta-2 agonist inhaled therapy, or in patients with an FEV1 of < 50%
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Inhaled steroids have been shown to decrease annual FEV1 ______, decrease the number of exacerbation and improve a quality of life.
Question Answer
A meta-analysis of 12 trials showed a NNT of ____ to _____ months to prevent 1 exacerbation?12; 18
List common side effects of ICS?oral candidiasis and easy bruising of the skin
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COMBINATION INHALED CORTICOSTEROIDS / BETA-2 AGONISTS
Question Answer
List examples of combination ICS / LABA products?1) fluticasone /salmeterol (Advair). 2) budesonide/formoterol (Symbicort)
What do these do?reduce exacerbation and improve quality of life more than LABA but at similar rates to ICS alone.
What are side effects?similar to those of the individual components
Using the GOLD criteria, what is the recommended treatment for GOLD group A?Initial treatment is SABA or SAAC (short-acting anticholinergic). Secondary treatment is LABA, LAAC (long acting anticholinergic) or combination LABA / LAAC
Using the GOLD criteria, what is the recommended treatment for GOLD group B?Initial treatment is LABA or LAAC. Secondary treatment is combination LABA / LAAC
Using the GOLD criteria, what is the recommended treatment for GOLD group C?Initial treatment is ICS / LABA or LAAC. Secondary treatment is LABA / LAAC]
Using the GOLD criteria, what is the recommended treatment for GOLD group D?Initial treatment is ICS / LABA or LAAC. Secondary treatment is ICS / LABA or ICS / LABA / LAAC
*** Smoking cessation is recommended for all patients with COPD who smoke, true or false?true
Cessation is associated with reduced declines in _____ and lower mortality?FEV1
The USPSTF recommends using the " 5 A" approach to tobacco cessation, what are these?Ask, Advise, Asses, Assist, Arrange
List pharmacotherapy that can assist with smoking cessation?nicotine replacement therapy, Bupropion, Varencline (Chantix)
Are mucolytic routinely recommended for treatment of COPD?no
Does prophylactic antibiotics and oral steroids prevent exacerbation of COPD?no
Long term oxygen therapy may be necessary for patients with ______to _____ COPD?moderate; severe
*** A Cochran review demonstrate improvements in survival when patients with COPD and a resting partial pressure of oxygen of < ____ mmHg were treated with oxygen?55
Oxygen saturation should be measured via pulse oximetry or arterial blood gas sampling after a patient breathes room air for ____ minutes or more?30
Patients who use supplemental oxygen should do so for a minimum of ____ hours per day, with a goal oxygen saturation of ____% to ____%?15; 88; 92
Patients w/ COPD should receive an annual ____ vaccine. Both the 23 and 13 valent pneumococcal polysaccharide vaccines should be administered according to the recommends of the CDC?flu
*** SUMMARY = COPD is a common problem diagnosed with a post-bronchodilator FEV1/FVC ration of < _____on spirometry?0.70
*** SUMMARY = Smoking causes ___% to ____% of cases; smoking cessation improves lung function and slows the progression of COPD?80; 90
*** SUMMARY = The GOLD guidelines stratify patients into 4 risk categories (A,B, C, D) based on what?1) spirometry results 2) frequency of exacerbation and symptom scoring 30 with treatment intensity based on risk group
*** SUMMARY = Pts w/ COPD should receive what vaccines per CDC recommendations. Patients in categories ___. ____, _____ are likely to benefit from pulmonary rehabilitation?1) flu, pneumonia. 2) B, C, D
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