PHRD5985 Pharmacotherapy Lecture 10 - COPD Management

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daynuhmay
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269730
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PHRD5985 Pharmacotherapy Lecture 10 - COPD Management
Updated:
2014-04-08 06:25:10
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COPD
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COPD
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  1. #1 risk factor for COPD
    smoking
  2. genetic risk factor for COPD
    AAT deficiency
  3. COPD should be suspected in any adult over age ___ years w/ classic sx, exposure to risk factors, or family hx
    40 years
  4. gold standard for screening of pts suspected of (or at risk for) COPD
    spirometry
  5. parameters evaluated by spirometry (2)
    • FVC (forced vital capacity)
    • FEV1
  6. FEV1/FVC ratio that confirms presence of persistent airflow limitation
    <0.70 (post SABA)
  7. PFT results in COPD (3)
    • 1) inc total lung capacity
    • 2) inc residual volume
    • 3) dec diffusion capacity
  8. GOLD Grade 1 %predicted FEV1
    80%
  9. GOLD Grade 2 %predicted FEV1
    50-79%
  10. GOLD Grade 3 %predicted FEV1
    30-49%
  11. GOLD Grade 4 %predicted FEV1
    <30%
  12. GOLD Group A
    • 1) Grade 1 or 2
    • 2) CAT <10
    • 3) mMRC 0-1
    • 4) 0-1 exacerbations in 12mos
  13. GOLD Group B
    • 1) Grade 1 or 2
    • 2) CAT 10
    • 3) mMRC 2
    • 4) 2 exacerbations in 12mos
  14. GOLD Group C
    • 1) Grade 3 or 4
    • 2) CAT <10
    • 3) mMRC 0-1
    • 4) 0-1 exacerbations in 12mos
  15. GOLD Group D
    • 1) Grade 3 or 4
    • 2) CAT 10+
    • 3) mMRC 2+
    • 4) 2+ exacerbations in 12mos
  16. non-pharm recommendations for stable COPD (5)
    • 1) smoking cessation
    • 2) vaccinations
    • 3) pulmonary rehab
    • 4) oxygen
    • 5) surgery
  17. pharmacologic options for management of stable COPD
    • 1) inhaled bronchodilators: SABA, LABA (b2-agonists); SAMA, LAMA (anticholinergics)
    • 2) ICS
    • 3) PDE4 inhibitor
    • 4) oral bronchodilator: theophylline
  18. GOLD Group A pharm management
    SABA prn
  19. GOLD Group B pharm management
    LABA or LAMA (+SABA prn)
  20. GOLD Group C pharm management
    ICS + LABA (or LAMA) + SABA prn
  21. GOLD Group D pharm management
    ICS + LABA +/or LAMA (+SABA prn)
  22. mainstay of COPD therapy
    bronchodilators
  23. inhaled salmeterol or formoterol (LABA) dosing
    1inhq12h
  24. nebulized formoterol or aformoterol (LABA) dosing
    nebq12h
  25. inhaled indacaterol (LABA) dosing
    inh contents of 1 capsule q24h
  26. SABA (albuterol, levalbuterol) dosing
    2inh q4-6h
  27. tiotropium (LAMA) dosing
    inh contects of 1 capsule q24h
  28. aclidinium (LAMA) dosing
    1inh q12h
  29. ipratropium (SAMA) dosing
    2-3inh q6h
  30. Combivent Respimat (SAMA + SABA) dosing
    1inh q6h
  31. Anoro Ellipta (LAMA + LABA) dosing
    1inh q24h
  32. bronchodilator not rec'd unless all others unavailable
    theophylline (oral bronchodilator)
  33. desired theophylline serum concentration
    8-12mg/L
  34. drug option NOT recommended as monotherapy in COPD
    ICS
  35. Symbicort (ICS + LABA) dosing
    2inh q12h
  36. Advair Diskus (ICS + LABA) dosing
    1inh q12h
  37. Breo Ellipta (ICS + LABA) dosing
    1inh q24h
  38. roflumilast MOA
    PDE4 inhibitor -> dec cAMP metab -> inc cAMP in lung cells
  39. alternative choice for GOLD Groups C & D
    roflumilast
  40. roflumilast dosing
    500mcg po once daily
  41. roflumilast contraindication
    moderate to severe liver impairment (Childs Pugh B & C)
  42. antibiotic (azithromycin) therapy dosing
    250mg po daily
  43. management of acute exacerbation w/ antibiotics
    • in hospitalized/ED pts w/ inc sputum purulence & inc dyspnea/sputum volume
    • treat for 5-10 days
  44. management of acute exacerbation with systemic CCS
    prednisone/prednisolone 40mg PO daily x 5d
  45. COPD exacerbation = major risk factor for ____
    VTE

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