Notes in COPD

To Subscribe, use this Key


Status Last Update Fields
Published 09/08/2024 •{{c1::Soft Mist inhaler (SMI)}} are a {{c2::respimat }}device - forcing a metered dose of drug through a nozzle that creates a mist
Published 09/08/2024 •{{c1::Nebulizers}} used for patients with poor inspiratory function 
Published 09/08/2024 {{c2::Muscarinic Cholinergic Antagonists (SAMA & LAMA)}} mechanism of action: Block the effects of {{c1::acetylcholine (Ach)}} whic…
Published 09/08/2024 Ach leads to broncho{{c1::constriction}} and promotes increased tracheobronchial secretion of endogenous Ach at {{c1::muscarinic}} rece…
Published 09/08/2024 SAMAs are used as {{c1::intermittent}} use/”{{c1::rescue}}” therapy
Published 09/08/2024 LAMA use: • Improve {{c1::lung function (FEV1)}} • Decrease {{c2::exacerbations}} • Decrease use of {{c2::rescue}} meds •Improve&n…
Published 09/08/2024 antibiotics are warranted in patients with increased {{c1::dyspnea}}, sputum {{c1::volume}}, and sputum {{c1::purulence }}
Published 09/08/2024 antibiotics are warranted in patients with increased {{c1::sputum purulence}} plus increased {{c1::dyspnea}}, OR sputum&…
Published 09/08/2024 antibiotics are warranted in patients requiring {{c1::mechanical ventilation}}
Published 09/08/2024 The recommended length of antibiotic therapy is usually {{c1::5-7}} days except {{c2::azithromycin}} can be given for {{c1::3}} days
Published 09/08/2024 6aca207941ab4e86b2316242406a1db0-oa-1
Published 09/08/2024 6aca207941ab4e86b2316242406a1db0-oa-2
Published 09/08/2024 6aca207941ab4e86b2316242406a1db0-oa-3
Published 09/08/2024 6aca207941ab4e86b2316242406a1db0-oa-4
Published 09/08/2024 6aca207941ab4e86b2316242406a1db0-oa-5
Published 09/08/2024 All patients with COPD should receive {{c1::pneumococcal}} vaccine, annual {{c1::influenza}} vaccine, {{c2::Tdap}}, and {{c2::COVID-19}} vaccinations
Published 09/08/2024 •PRN {{c1::SABA}} or {{c1::SAMA}} for all stages!
Published 09/08/2024 •Inhaler {{c1::technique}} & {{c1::adherence}} is key
Published 09/08/2024 •{{c1::Smoking}} cessation is important for COPD
Published 09/08/2024 •Consider {{c1::financial/insurance}} status of patient is important for treatment for COPD
Published 09/08/2024 COPD: a common, preventable and treatable disease that is characterized by {{c1::persistent}} respiratory symptoms and airflow {{c1::limitat…
Published 09/08/2024 {{c1::smoking cessation}}, {{c1::flu}} + {{c1::pneumococcal}} vaccines are survival benefits in ALL groups of COPD  
Published 09/08/2024 all groups except {{c1::A}} may consider pulmonary rehabilitation 
Published 09/08/2024 {{c1::PRN SABA}} or {{c1::SAMA}} for all stages of COPD 
Published 09/08/2024 {{c1::Sympathetic}} nervous system: {{c2::β2}} receptors responsible for {{c3::relaxation}} (broncho{{c3::dilation}}) if stimulated
Published 09/08/2024 {{c1::Parasympathetic}} nervous system: {{c2::M₃}} receptors responsible for {{c3::contraction}} (broncho{{c3::constriction}}) if stimulated
Published 09/08/2024 {{c1::mMRC}}: shortness of breath assessment
Published 09/08/2024 {{c1::CAT assessment}}: includes how the disease is impacting their quality of life
Published 09/08/2024 {{c1::SABAs}} are used as a rescue therapy and have a quick onset to manage acute symptoms in COPD
Published 09/08/2024 side effects of b2-agonists in heart:β1:: ↑ {{c2::myocardial contractility}}, {{c2::tachy}}cardia, cardiac {{c2::dysrhythmias}}β2:&nbsp…
Published 09/08/2024 side effects of b2-agonists in vasculature:β2: {{c1::vasodilation}}
Published 09/08/2024 side effects of b2 agonists in the skeletal:β2: ↑ {{c1::neuromuscular transmission (tremor)}}
Published 09/08/2024 side effects of b2-agonists in metabolism:β1: {{c1::glycogenolysis}}, {{c1::lipolysis}}β2: {{c2::gluconeogenesis}}, {{c2::hypokale…
Published 09/08/2024 {{c1::SAMAs}} are for intermittent use and rescue therapy 
Published 09/08/2024 {{c1::LABAs}} and {{c1::LAMAs}} indications are the the same 
Published 09/08/2024 local side effects of muscarinic receptor antagonists are occasional {{c1::metallic taste}}, {{c1::dry mouth}}
Published 09/08/2024 other side effects of muscarinic receptor antagonists are {{c1::nausea}}, possible {{c1::urinary retention}} in elderly patients
Published 09/08/2024 {{c1::ICS}} are NOT recommended as monotherapy in COPD
Published 09/08/2024 ICS + LABAs increase {{c1::eosinophils}}
Published 09/08/2024 Long term treatment of ICS + LABA is recommended for patients with severe and very severe airflow {{c1::limitation}} and those with frequent…
Published 09/08/2024 withdrawal of {{c1::ICS + LABA}} may lead to exacerations of COPD
Published 09/08/2024 ICS + LABA may increase the risk of {{c1::PNA}}
Published 09/08/2024 long term use of {{c1::systemic corticosteroids}} is NOT recommended for COPD
Published 09/08/2024 {{c1::systemic corticosteroids}} are only used in exacerbations to reduce rate of treatment {{c2::failure}}, reduce rate of {{c2::relap…
Published 09/08/2024 side effects of {{c1::systemic corticosteroids}} are {{c2::peptic ulcer}}, GI bleed, weight {{c2::gain}}, hyperglycemia, osteoporosis, {{c2:…
Published 09/08/2024 {{c2::short}} acting systemic corticosteroids are {{c1::Cortisone}} and {{c1::Hydrocortisone}}
Published 09/08/2024 {{c2::intermediate}} acting systemic corticosteroids are:{{c1::Methylprednisolone}},{{c1::Prednisone}}, {{c1::Prednisolone}}, {{c1::Triamcin…
Published 09/08/2024 {{c2::long}} acting systemic corticosteroids is {{c1::betamethasone}}
Published 09/08/2024 {{c1::Roflumilast}} is a {{c2::Phosphodiesterase-4-inhibitor }}
Published 09/08/2024 {{c3::Phosphodiesterase-4-inhibit}} MOA is that they are a selective oral PDE4 inhibitor and ↑ {{c1::intracellular cAMP}} and reduced l…
Published 09/08/2024 {{c2::PDE4 inhibitors}} are indicated to reduce the risk of exacerbations in patients with severe COPD associated with {{c1::chronic bronchi…
Published 09/08/2024 you want to add on a {{c2::PDE4-I}} to  LABA/LAMA if {{c1::eosinophil}} count <100 cells/µL
Published 09/08/2024 Can add {{c1::PDE4-I}} to LABA/LAMA/ICS → consider if FEV1 < {{c2::50}}% + chronic {{c2::bronchitis}} (especially is at le…
Published 09/08/2024 DO NOT USE {{c1::PDE4-I (Roflumilast)}} WITH {{c2::THEOPHYLLINE}}
Published 09/08/2024 {{c2::diarrhea}}, {{c2::nausea}}, weight {{c2::loss}}, and psychiatric effects like {{c2::insomnia}}/{{c2::depression}} are side effects of {{c1::PDE4…
Published 09/08/2024 {{c1::PDE4-I}} is metabolized by CYP3A4 + 1A2, use of strong inducers is not recommended, use of inhibitors may increase adverse reactions
Published 09/08/2024 {{c2::Methylxanthines}} are a nonselective {{c3::PDE}} {{c1::inhibitor}} and {{c3::Adenosine}} receptor {{c1::antagonists}}
Published 09/08/2024 Inhaled bronchodilators are preferred so use of methylxanthines is {{c1::rare}}
Published 09/08/2024 out of the methylxanines, {{c1::Aminophylline}} (IV) is no longer recommended for use, too many side effects
Published 09/08/2024 GI adverse effects of {{c2::methylxanthines}}:{{c1:: N/V/D}}, {{c1::dyspepsia}}, {{c1::abdominal}} pain
Published 09/08/2024 CNS adverse effects of {{c2::methylxanthines}}: {{c3::headache}}, {{c3::insomnia}}, {{c1::dizziness}}, {{c1::agitation}}, {{c…
Published 09/08/2024 Cardiac adverse effects of {{c2::methylxanthines}}:{{c1::tachycardia}}, {{c1::arrhythmias}}
Published 09/08/2024 MSK effects of {{c2::methylxanthines}}:{{c1::tremor}}, {{c1::muscle cramps}}
Published 09/08/2024 other agents for COPD:{{c1::Antitussives}}: :Dextromethorphan, CodeineRegular use not recommended
Published 09/08/2024 {{c1::Mucolytic}} agents:Acetylcysteine (NAC)CarbocysteineErdosteineBenefit unclear
Published 09/08/2024 New evidence suggests azithromycin may decrease the {{c1::frequency}} of exacerbations (not currently supported)
Published 09/08/2024 Abx: continuous use {{c1::not}} historically recommended (AE: {{c2::hearing}} loss, {{c2::QTc prolongation}}, abx resistance)
Published 09/08/2024 Use of {{c1::antibiotics}} may be considered in {{c2::non-smoking}} pts treated with LABA/LAMA/ICS with repeated exacerbations
Published 09/08/2024 {{c1::Nebulizer}}: especially good for those with poor inspiratory efforts and young children, requires no breath coordination
Published 09/08/2024 {{c1::Metered dose inhaler (MDI)}}: delivers medication from a pressurized canister using a propellant but requires patient to coordinate breath and a…
Published 09/08/2024 {{c1::Dry powder inhaler (DPI)}}: breath-actuated device that requires sufficient airflow to inhale the medication from the device (breath-dose coordi…
Published 09/08/2024 Spiriva handihaler: DO NOT SWALLOW THE {{c1::CAPSULE}}
Published 09/08/2024 Short acting (SABA / SAMA): {{c1::Albuterol / Ipratropium}}
Published 09/08/2024 Long acting (LABA / LAMA){{c6::Formoterol}} / {{c3::aclidinium}}{{c6::vilanterol}} / {{c3::umeclidinium}}{{c5::olodaterol}} /…
Published 09/08/2024 Therapeutic goals: prevent and control {{c1::symptoms}}reduce {{c2::frequency}} and {{c2::severity}} of exacerbationsimprove&…
Published 09/08/2024 General principles: treatment tends to be {{c1::cumulative}}regular treatment needs need to be {{c4::maintained}} for long periods of timecareful…
Published 09/08/2024 group {{c2::C}} gets a {{c1::LAMA}}
Published 09/08/2024 group {{c2::A}} gets a {{c1::short or long acting bronchodilator}} 
Published 09/08/2024 group {{c1::D}} gets a {{c2::LAMA}} or {{c2::LAMA + LABA}} (consider if {{c3::highly symptomatic e.g. CAT>20}}) or {{c2::ICS + LABA}} (consider if …
Published 09/08/2024 group {{c2::B}} gets a {{c1::long acting bronchodilator (LABA or LAMA)}}
Published 09/08/2024 if group B has severe restlessness, may consider {{c1::2 bronchodilators}} as initial therapy 
Published 09/08/2024 AECOPD definition: -acute {{c1::worsening}} of baseline symptoms (dyspnea, cough, sputum) may warrant a change in {{c2::maintenanc…
Published 09/08/2024 AECOPD Mild: treated with {{c1::short acting bronchodilators}} only
Published 09/08/2024 AECOPD Moderate: treated with {{c1::short acting bronchodilators}} + {{c1::antibiotics}} and/or {{c1::oral corticosteroids}}
Published 09/08/2024 AECOPD Severe: patients requiring hospitalization or visits to the emergency room, may be associated with {{c1::acute respiratory failure}}
Published 09/08/2024 Indications for admission for AECOPD: failure to respond to {{c5::initial}} managementmarked increase in symptom {{c6::intensity}}significan…
Published 09/08/2024 Bronchodilators in AECOPD: Increase {{c1::dose}} and/or {{c1::frequency}}{{c2::SABA}} +/- {{c2::ipratropium}}Use {{c3::nebuli…
Published 09/08/2024 Systemic corticosteroids in AECOPD:Indications: {{c1::hospitalized}} patients, patients at home not responding to {{c1::bronchodilators}} af…
Published 09/08/2024 antibiotics in COPD are indicated for 3 patient populations:Patients with {{c1::increased dyspnea}}, {{c1::sputum volume}}, AND {{c1::sputum puru…
Published 09/08/2024 Summary of AECOPD therapeutic plan: {{c1::Titrate}} supplemental oxygen to a target of 88-92%{{c2::ipratropium/albuterol}} Q6 hours{{c3…
Published 09/08/2024 Treatment of COVID-19 in patients with COPD: lacking subgroup data for patients with COPD, use the {{c1::same}} standard of care treatments …
Published 09/08/2024 {{c1::Tiotropium}}, {{c1::Aclidinium}}, {{c1::Umeclidinium}}, {{c1::Glycopyrrolate}} are {{c2::LAMAs}}
Published 09/08/2024 {{c2::Ipratropium}} is an {{c1::SAMA}}
Status Last Update Fields