CC Sept 2017 COPD exacerbation and steroid use

echoecho's version from 2017-10-22 17:13


Question Answer
Up to ____ of patients with COPD have an acute exacerbation of their illness annually and a significant percentage of these patients require hospitalization?half
List the common triggers of COPD exacerbation?1) upper respiratory infections 2) lower respiratory infections 3) medication nonadherence 4) air pollution 5) heart failure 6) pulmonary embolism
Exacerbations are to do what?1) inflammation 2) alterations of the microbiome 3) impaired gas exchange 4) airflow obstruction
What treatment specifically targets the inflammation associated with COPD exacerbations?systemic corticosteroids
List the side effects of systemic steroids?1) hyperglycemia 2) osteoporosis 3) elevated BP
*** A 2014 Cochrane review of 16 studies and > 1700 patients found that compared to placebo, patients treated with corticosteroid had what outcomes?1) less likely to have treatment failure or require intubation 2) more likely to have shorter hospital stays and shorter time to improvement in breathlessness and lung function
When compared head to head, there was no difference in outcomes between IV and oral corticosteroids, except a higher incidence of ______ in patients receiving IV steroids?hyperglycemia
While all the major guidelines agree on the use of steroids for acute exacerbation of COPD, there is not universal consensus on ______ of therapy?duration
In 2016, the European Respiratory Society and American Thoracic Society make the following recommendations concerning the use of corticosteroids for acute exacerbations?1) patients with mild exacerbations treated in an ambulatory setting should receive oral steroids for 14 days or less (conditional recommendations, very low-quality evidence) 2) patients admitted to the hospital with COPD exacerbation should receive oral corticosteroids if gatrointestinal function is intact (conditional recommendations, low quality evidence). Otherwise, IV steroids should be used
A 2014 Cochrane review of hospitalized patients with exacerbations of serve COPD, found that shorter duration of oral steroid therapy (about ____ days) did NOT show worse outcomes than therapy lasting 10-14 days. The evidence was judged moderate in quality?5
The GOLD (Global Initiative for COPD) guidelines, revised in 2017, recommends _____ days of oral prednisone at a dose of ____ mg for patients with mild exacerbations treated in an ambulatory setting?5; 40 mg
GOLD guidelines also suggests the use of _____ corticosteroids for patients admitted to the hospital with an exacerbation?oral
*** SUMMARY = Acute exacerbations of COPD are serious and costly complications of the disease, _____ steroids have long been an integral tool in treating these episodes?systemic
*** SUMMARY = What does steroids do?1) reduces inflammation 2) improves air flow and patient symptoms 3) reduces the risk of treatment failure 4) shortens hospital stays
*** SUMMARY = Oral steroids given over a short (____ day) period appear as helpful as the IV route or using oral steroids for a longer duration. Oral steroids are ______ in both hospital and outpatient settings?5; effective