Know Your COPD Patient
What physical assessment findings in TM’s case are consistent with COPD? Name 3.
• Tripoding
• Pursed-lip breathing
• Increased work of breathing
• Decreased breath sounds and slight coarse crackles with inspiration in all lung fields
• Hyperresonance on percussion
What are the 3 cardinal symptoms that support antibiotic use in AECOPD?
• increased dyspnea
• increased sputum volume
• increased sputum purulence
Based on TM’s FEV1 of 58% predicted, what is her GOLD grade?
GOLD Grade 2
TM was using Spiriva Respimat before admission. What is the active ingredient and class?
Tiotropium, LAMA
What information suggests TM may have higher nicotine dependence?
• First cigarette within 20 minutes of waking
• 10–14 cigarettes/day
• 50 pack-year history
• Long smoking history
What is TM’s main modifiable risk factor for COPD progression and future exacerbations?
• Active smoking
• 10–14 cigarettes/day
• 50 pack-year history
• First cigarette within 20 minutes of waking
What common bacterial pathogens are associated with uncomplicated COPD exacerbation? Name 2.
any 2 of 3:
• Haemophilus influenzae
• Streptococcus pneumoniae
• Moraxella catarrhalis
What GOLD A/B/E category is TM in if her mMRC score is 1?
GOLD Group E
Why is tiotropium Respimat held while TM is receiving scheduled ipratropium nebulizers in hospital?
• Both are anticholinergic bronchodilators
• Ipratropium is used acutely for exacerbations
• Tiotropium is maintenance therapy
Why is smoking cessation an important goal in TM’s COPD management?
• Slows COPD progression
• Reduces future exacerbation risk
• Improves long-term respiratory outcomes
• Reduces morbidity/mortality
• Reduces smoking-related cancer/CV risk
What vital signs supported that TM was acutely unwell from a respiratory standpoint?
• RR 26 (tachypnea)
• HR 112 (tachycardia)
both are consistent with COPD
What factors make an oral antibiotic step-down reasonable in TM?
• Able to take PO
• Afebrile
• Clinically improving/stable
• No severe infection signs
• Narrow oral option available
What daily COPD maintenance therapy is TM missing given her exacerbation history and uncontrolled symptoms?
LAMA/LABA combination
What patient-specific factors should be assessed when choosing an inhaler device for TM?
• Inspiratory flow
• Hand strength
• Dexterity
• Coordination
• Vision
• Ability to use device correctly
• Patient preference
• Cost/coverage
• Adherence
TM has tried multiple NRT options before and wants pharmacotherapy. What medication could be recommended? State the drug, dose, frequency, route, duration.
Varenicline 0.5 mg on days 1-3 and then 0.5 mg twice daily on days 4-7 and then 1 mg twice daily on day 8 for 12 weeks
or
Bupropion 150 mg daily PO × 3 days then 150 mg BID PO × 7–12 weeks. Begin 1–2 week before the selected quit date
What COPD goals of therapy are most relevant for TM after discharge? Name 3.
• Reduce frequency/severity of exacerbations
• Improve dyspnea and respiratory symptoms
• Improve ability to go for longer walks / exercise
• Reduce disease progression
• Reduce mortality
• Support smoking cessation
What first-line oral antibiotic is recommended for TM? What is a reasonable alternative? State drug, dose, frequency, route, duration.
• Amoxicillin 1000 mg TID PO × 5 days
or
• Doxycycline 200 mg PO once, then 100mg PO BID x 5 days
or
• SMX / TMP 800/160 mg (2 regular-strength tablets or 1 double-strength tablet) BID PO × 5 days
What is one appropriate LAMA/LABA option for TM after her exacerbation is managed?
Inspiolto Respimat
- tiotropium 2.5 mcg/olodaterol 2.5 mcg, 2 inhalations once daily
TM has poor inspiratory flow due to COPD. Which inhaler device type may be less suitable?
A. Soft mist inhaler
B. Nebulizer
C. Dry powder inhaler
D. MDI with spacer
C. Dry powder inhaler
What should be monitored for varenicline safety?
• Nausea
• Insomnia
• Vivid dreams
• Mood changes
• Behaviour changes
• Adherence/tolerability
What key medication is missing from TM's acute COPD exacerbation management? State the drug, dose, frequency, route, duration.
Prednisone 50mg once daily PO x 5 days
or
Methylprednisolone 40 mg IV daily if PO not appropriate
What is the risk of continuing ceftriaxone when a narrower oral option is appropriate?
• Unnecessary broad-spectrum exposure
• Increased antimicrobial resistance
• IV-related burden
• Potential adverse effects
Under what conditions would TM require or be considered for add-on ICS therapy?
• Continued exacerbations despite optimized LAMA/LABA
• Elevated blood eosinophils
• Stronger consideration if eosinophils ≥300 cells/µL
• Consider if eosinophils ≥100 cells/µL with ongoing exacerbations
Which alternative LAMA/LABA inhaler listed in TM’s workup may be affected by hand strength, dexterity, inspiratory flow, or device technique concerns?
A. Spiriva Respimat
B. Inspiolto Respimat
C. Duaklir Genuair
D. Salbutamol MDI
C. Duaklir Genuair
What counselling points should be included when starting TM on smoking cessation therapy?
• Set quit date
• Explain dosing/titration
• Discuss common ADRs
• Plan for cravings/triggers
• Encourage behavioural support
• Arrange follow-up