Asthma/COPD Basics

Spirometry

100

How much air can be forcefully exhaled in one second

FEV₁

200

After taking a deep breath, the maximum volume of air that is exhaled

FVC

300

The percentage of total air capacity (“vital capacity”) that can be forcefully exhaled in once second (the speed of the exhale)

FEV1/FVC

Asthma Assessment

100

The four components included in GINA's assessment of asthma control

1. daytime asthma symptoms 2. night waking or coughing due to asthma 3. reliever needed for symptoms 4. activity limitations due to asthma

200

Level of asthma control if patient has asthma symptoms and uses inhaler more than twice per week and wakes coughing two times over the last 4 weeks (uncontrolled; poorly controlled; well controlled)

Uncontrolled

300

The medication class that is used to help diagnose asthma by identifying if the expiratory airflow limitation is reversible

bronchodilator

Asthma Treatment

100

Medication class that should never be used alone for asthma treatment and reason for this

Long acting B-2 agonists; increased risk of death

200

The medication that can be used both as both a reliever and a controller (Brand and Generic)

Symbicort (budesonide-formoterol)

300

Two medication therapy options if patient's asthma is poorly controlled using only albuterol as needed

1. Switch to ICS-formoterol 2. Add daily low dose ICS (less preferred options: daily LTRA or low dose ICS taken whenever SABA taken)

Asthma Treatment Details

100

Medication class associated with oral thrush

Inhaled corticosteroids

200

Three adverse effects associated with SABA use

tremor, nervousness, tachycardia, palpitations, headache, hyperglycemia, hypokalemia, paradoxical bronchospasms

300

Three side effects associated with Advair Diskus use

ICS: higher prevalence of oral candidiasis, hoarse voice, skin bruising, pneumonia

LABA: headache, neuromuscular and skeletal pain, throat irritation, paradoxical bronchospasms

COPD Assessment

100

Two tools used to assess COPD symptoms

1. COPD Assessment Tool (CAT) Scoring Tool 2. Modified Medical Research Council (mMRC) Questionnaire

200

The number of exacerbations that warrants a C or D using the ABCD assessment tool

2+ or 1+ leading to hospitalization

300

The treatment group (i.e., A, B, C, D) associated with 2 exacerbations and CAT score of 10

Group D

COPD Treatment

100

The best medication class to recommend as an addition if COPD is uncontrolled due to dyspnea with Serevent Diskus only

LAMA (tiotropium (Spirivia), umeclidinium (Incruse), Aclidinium DPI (Tudorza Pressair), and Glycopyrrolate DPI (Seebri Neohaler))

200

Specific medication class to use if patient has lots of hospitalizations for exacerbations and eosinophil level 100+

inhaled corticosteroids

300

Within group D, name two combination medications that would be preferred if a patient is highly symptomatic (CAT > 20)

1. Umeclidinium-vilanterol (Anoro Ellipta) 2. tiotropium-olodaterol (Stiolto Respimat) (Others: Indacaterol-Glycopyrrolate (Utibron Neohaler) or Glycopyrrolate-Formoterol (Bevespi Aerosphere))

COPD Treatment Details

100

Side effects associated with SAMA/LAMA

Anticholinergic side effects: dry mouth, headache, urinary retention, upper resp. infections

200

The medication class that should be stopped if a patient develops pneumonia

ICS

300

This is a potential problem with Ellipta and Diskus type inhalers versus HFA and MDI

Inability to inhale deeply or strong enough to get adequate dose of medication