End-Stage COPD
Prognosis
Optimal Therapy
AECOPD
Huffin and Puffin
100
According to the Global Initiative on Chronic Obstructive Lung Disease (GOLD). GOLD 4 or Very Severe COPD is defined by a post bronchodilator FEV1 of this?
What is <30% predicted
100
The highest score on the BODE index predicts 88% 4-year mortality in COPD. B is for BMI<21, O is for Obstruction with FEV1<30%, D is for Dyspnea mMRC 4 and E is for this?
What is Exercise Capacity (6 minute walk distance) less than 149 meters?
100
In patients with advanced COPD, this multi-faceted non-pharmacologic intervention is associated with improved HRQL and decreased health resource utilization.
What is Pulmonary Rehab/Disease Self Management?
100
A 2017 Cochrane review of 28 trials involving more than 3800 patients found that COPD patients who were provided with this intervention in advance of AECOPD had improved QOL and fewer hospital admissions related to their disease.
What is a written COPD Action Plan?
Lenferink et al. Self-management interventions including action plans for exacerbations versus usual care in patients with chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2017
100
A 2011 pharmacovigilance study found that once daily long-acting Oral Morphine was safe, effective and tolerable in reducing refractory dyspnea for the majority of COPD patients but that doses beyond this limit were associated with diminishing returns due to increased drug related side effects and complications.
What is 30 mg per day?
Once-Daily Opioids for Chronic Dyspnea: A Dose Increment and Pharmacovigilance Study
200
Too breathless to leave the house or breathless when dressing and undressing
What is mMRC 4 class dyspnea
200
This is the average reduction in life expectancy for a 65 year old patient with GOLD stage 4 COPD who continues to smoke.
What is 10 years?
200
In COPD patients with persistent resting hypoxemia, these are the only two interventions shown to reduce mortality.
What are Smoking cessation and supplemental oxygen
CTS Guideline 2017
200
Based on a Cochrane Review of duration of steroid therapy in AECOPD. I am the number of days of steroid therapy shown to be non-inferior to longer courses of therapy.
What is 5 days?
200
The American Thoracic Society defines this as sustained and severe resting breathing discomfort that occurs in patients with advanced, often life-limiting illness and overwhelms the patient and caregivers’ ability to achieve symptom relief.
What is Dyspnea Crisis?
300
Compared to patients with unresectable lung cancer, patients with advanced COPD experience significantly worse symptom burden and impairments physical, social, and emotional functioning. Beyond dyspnea, this was found in up to 90% of patients vs. 52% in lung cancer.
What is clinically relevant depression/anxiety?
300
In addition to GOLD spirometry criteria, these two additional factors are used to determine COPD severity and are independently associated with increased risk of poor HRQL and mortality
What are AECOPD frequency and functional limitation due to dyspnea (CAT/MRC)
300
In patients with stable COPD, this yearly intervention has been shown to reduce the incidence of lower respiratory tract infection, serious illness, hospitalization and death.
What is influenza vaccination?
300
For Co-Morbid patients with Gold stage 3/4. I am the first line empiric antibiotic therapy for purulent acute exacerbations of COPD.
300
Opioids are thought to exert many of their dyspnea reducing properties through attenuation of responses in this part of the brain
What is the limbic system, amygdala, pre-frontal cortex
400
In 2013, the COPD IMPACT study evaluated a comprehensive home-based palliative care intervention in 30 patients with advanced COPD. Sixteen (53%) patients died within 18 months of study enrollment. The intervention was associated with a home death rate of this.
What is zero percent?
400
This 8 item questionnaire assesses the global impact of symptoms in COPD and is used to further stratify disease severity/risk. It is independently associated with mortality.
What is CAT, the COPD Assessment Test
400
Aclidinium and Umeclidineum are both drugs in this class and have been shown to further improve QOL and reduce frequency of acute exacerbations in patients with moderate to severe symptoms when added to long acting B2 agonists
What is LAMA?
400
AECOPD is defined a sustained change in respiratory status a heralded by at least 2 of the following:increased dyspnea, increased sputum volume, increased sputum purulence
Sustained is defined as this:
What is at least 48 hours?
400
A 2017 mixed methods study found that 78% of participants perceived reduction in dyspnea associated with this non-pharmacologic intervention.
What is a hand held fan?
500
RCT evidence indicates that this intervention is comparable to NIPPV in reducing need for intubation in hypoxic respiratory failure and is superior in reducing dyspnea and respiratory rate.
What is HFNC? (AIRVO)
500
A 2011 RCT in patients with advanced COPD and chronic resting hypercapnia (PC02>53) showed that adding this to pulmonary rehabilitation for a period of 2 years resulted in significant improvements in HRQoL, mood, dyspnea, gas exchange, exercise tolerance and lung function decline.
What is home-based nocturnal NIPPV?
500
The CTS recommends addition of this medication as 4th line therapy to prevent purulent acute exacerbations of COPD in patients who continue to experience frequent purulent AECOPD despite treatment with LAMA+LABA/ICS
What is an oral PDE4 inihibitor? (Roflumilast)
500
Early use of this intervention in patients with acute or acute-on-chronic respiratory failure due to a COPD exacerbation reduces the need for intubation, mortality, complications of therapy, length of hospital stay and length of ICU stay.
What is NIPPV?
Management of COPD exacerbations: a European Respiratory Society/American Thoracic Society guideline 2017
500
A 2010 RCT found that this commonly used intervention was no more effective than placebo in reducing dyspnea in patients with refractory dyspnea due to advanced pulmonary disease.
What is oxygen by nasal prongs?
