take a breath

fev1

forced expiratory volume in one secon d

how roflum (pde4) dif than Ensifentrine (pde3 and 4)

more anti-inflam, less bronchodilating

what trial proved lama/ba better to prevent exacerbation and pneoumonia risk

FLAME

fvc

forced vital capaticy

cat what mean . what same as

copd assesment test

• caat test== chronic airway assess test

what does emphysema mean

alveoli abnormalities

what IS copd

• hterogenous— broad impact

• chronic resp symptoms— dyspnea, cough, sputum production— less episodic than asthma

  • airway abrnomality AND/or alveoi abnorm

risks with azith

hearing loss, QT prolong, antibiotic sens loss

what does il4 an d 13 normally normal

increase FeNO and inflam cells

• promotes eosibnophil reposne

what does il5 normally do

drive gorwth maturation of eosinophils

• keeps them inflam cells going and comin

what does bronchitis mean

airway abnormalities

what is inflammed in acute bronchitis

small airway swell with mucus

• cough, sob, fever, fatigue, etc

risk factors for acute bronchitis

asthma, COPD, GERD,

autoimmune disorders, exposure to

smoke, chemicals, toxins

how long acute bronchitis last

a few week s

how long chronic bronch last

Chronic cough and sputum

production most days ≥ 3 months/yr for 2 consecutive years

what causes acute bronch

virus!

deeper— what is emphysema

alveoli destruction

• less stretchy; rupture

what kind of damage is what keeps air in lungs so can’t leave (obstructive lung disease)

Emphysema

Emphysema symptoms

dyspnea, DOE,

wheezing, cough, chest

tightness, fatigue, weight loss

dif between prevalence vs incidence

prevalence— new AND existing

incidence— just new cases

what is anotherrr type of inflammation in SOME copd patietns

type 2 immune-mediated

• il-4, il-5, il-9, il-13

whta is forced vital capacity

volume of air expired after complete inhalation. Total of TV, IRV, ERV

what are the main contributers to copd

genetics

environment

time/trajectory

diagnostic critera for cpod

fev1/fvc <70%

what is the mMRC

Modified Medical Research Council— assessment test for copd

how high score has to be on mMRC to show increased symptoms

over 2

• walks slower than others bc of breathlessness and worse

how is caat assessment conducted

self-administered questions

how high does cat/caat score have to be to show increased symptoms

greater than or equal to 10

is cat or mMRC pref

cat

how is pao2 affected? paco2? hct?

1. pao2— low

2. paco2— high— cant get it out

3. hct— increased bc tyring to increase oxygenation

what is best predictor of frequenet exacerbations

Hx of exacerbation in the past 12 months.

what is major genetic link that increases or decreases elasticity in alveoli

alpha 1-antitripsyn deficiency

what category is highest risk of exacerbations

E

• one or more exca, over past year

what is low risk for exacerbation but high symptoms category and what are critera

B

• mMRC >2

  • caat >10

what is BODE index for? what does acromyn mean

mortality risk

• bmi

• obstruction (fev1)

• dyspnea (mMRC)

• excerice tolerance

who gets inhaled steroids more?

asthma, less COPD patients

whats a pack year?

• packs per day times years

• ex if its 20 pack years— two packs per days times ten years, etc

what is moderate airflow obstruction severity (measured in % fev1 in relation to expected)

50-80%

what is qualifier for pts for airflow obstruction severity

must be in pts fev1/fvc less than 0.70

what is ecopd

exacerbation of copd

what can be used to predicut the magnitiude of ICS response on preventing exacervations

blood eosinophil count

what are accessory muscles for breathing

neck muscles, intercostal (rib)

why are blood eosinophil counts used to show how steriods could help in exacerbations

if higher, means more inflammatory WBCs floating around. so if higher, a de-inflam steriod would be MORE helpful

when is chest CT rec

CT if 50-80 yo w/ 20-pack years

smoking history to screen for lung cancer

why are exacerbations bad

worsen lung function (quickens the decreasing function with time)

are steriods ubiquitous in copd pts

NO only some get based on eosinophils

what is gorup E for symptoms and risk annd how qualify

HIGH RISK

• qualified by 1 or more exacerbations in past year

what is group B for symptoms/risk

low risk, high symptoms

• mMRC great/equal to 2

• caat great/equal 10

no exacerbations

what is the scoring with the fev1 % called

GOLD

what is cold very severe

under 30% fev1 of expected value

what is severe range for gold (% expected fev1)

30-50 %

what is fev/fvc diagnostic for copd

0.7

mild GOLD score (GOLD 1)

fev% greater than or equal to 80

what can you get in plethysmography that you can’t get in spirometry

residual volume

what is alpha 1 antiryptisin deficiecny and why indicative of copd

genetic disorder — less elastin to expand/contract the lungs

• AATD maintains concentrations by stopping enzyme that breaks down elastin called neutrophil elastase

what is range for bode mortality risk

next 4 years

what are the two goals for treatment of stable copd

1. reduce symptoms

   1. reduce risk of exaceratbions

just list out drug class categories used for stable COPD

1. bronchodilators (saba/laba/sama/lama/combos)

2. inhaled cort.roids (ics’s— eitehr laba/ics or laba/ma/ics)

3. pde inhib

4. biologics (IL -inhib)

5. antibiotcs

what is main perk of beta 2 ags

improvement in fev1

what do labas decrease risk of? what do they NOT decrease risk of

• decrease risk of dyspnea, exacerbations, hospitalizations

• no effect on mortality

duration of saba vs laba

sa: 4-6 hr

lab: 12-24

what do samas bind? how dif from lama?

sama— blcok m2/m3

lamas mostly m3, only short binding to m2

what do lamas decrease risk of/ what NOT decrease?

decrease exacerbations, hospital

• no effect on mortality

can ICS be used as monothearpy in copd

nooooo boxed warning durp

adrs of sama/lama

dry mouth, bitter/metallic taste (ipratropium), small increased risk of cardiac events (ipratropium)

are there lama/ ics combos

nooo no no

what drug is in the methylxanthine class

theophyllne

what is another word for theophylline or methylxanthine

non-selective pde inhibitor

WHEN should theophylline be used

onlyyy if other agnets not affordable

cons to theophyline

No consistent improvement in risk of exacerbations

 Metabolized by CYP450 (drug interactions)

 Requires careful monitoring

adr theophylline

HA, insomnia, nausea, seizures, arrhythmias

saba or sama which better

sama really but most ppl on albuterol for rescue

what drug linked to benefit of decreasing blood eosinophil count ? how high count be to get benefti

ICS

• >300 cells/mcl

adrs ICSs

Oral candida, hoarseness, bruising, pneumonia

• Possible increased blood glucose, cataracts, TB infection

major con of ICS

pneumonia

what needs assessment before changing current therapy

Technique and adherence should be assessed before

concluding that current therapy requires modification

• tricked yaaa its not a test

first line therpay for group E

laba+lama

• laba/ma/ICS if blood eso >300

group b first line

laba/lama

• no ibc ind

group a first line

laba OR lama

• long acting bronchodilators are the pref

when should just laba/ics be used in copd

only if concomitant asthma

what do ALL patietns get in copd

short-acting rescue inhaler

how to find eso count from CBC

multiple eos % by the WBC count (white blood cell count)

what is best in dyspena pts? what should NOT use

lama/laba combo

• NO ics

list laba/mas

Vilanterol/umeclidinium (Anoro Ellipta)

Olodaterol/tiotropium (Stiolto Respimat)

Formoterol/glycopyrrolate (Bevespi MDI)

Formoterol/aclidinium (Duaklir Pressair)

what in anoro

Vilanterol/umeclidinium (laba/ma)

what is in stiolto

Olodaterol/tiotropium (laba/ma)

what in bevespi

form/glycop (lama/ba)

what in dualkir

form/acldinunum (lama/ba)

what are the two lama/ba/ics products

Vilanterol/umeclidinium/fluticasone (Trelegy Ellipta)

Formoterol/glycopyrrolate/budesonide (Breztri MDI)

what is in trelegy

Vilanterol/umeclidinium/fluticasone (

what is in breztri

Formoterol/glycopyrrolate/budesonide

what in Serevent

salmetrol (laba)

hwhat in striverdi

olodaterol (laba)

what in brovana

arformoterol (laba)

what in incruse

umeclidium (lama)

what in spiriva

tiotropium

what is in tudorza

acldinium (lama)

what class is Ensifentrine

dual pde3, pde4 inhibitor

Ensifentrine what was benefit advertised in trial

limited use of bronchodil/ics; in ppl with fev1 30-70%, hisotyr of smoking 10pack years

Ensifentrine dose

3 mg bid nebulied for 24 weeks