A-cute affairs
When would you put a patient with AECOPD on NIV?
pH ≤7.35 OR
PaCO2 > 45 mmHg OR
Respiratory rate >20 bpm
How do you treat groups ABE? (Need all three correct)
A: A bronchodilator
B: LABA + LAMA
C: LABA + LAMA (can consider ICS if high eos)
What is the mechanism of action of Roflumilast?
Selective PDE-4 inhibitor
What drug did the BOREAS trial study which showed reduction in exacerbations, better lung function and quality of life, and less severe respiratory symptoms
Dupulimab
What is the name of the trial ongoing in CCF comparing Azithromycin versus Roflumilast in frequent exacerbators
RELIANCE (consider enrolling your patients!)
List three advantages of systemic steroids during an AECOPD
1. Shorten recovery time
2. Improve lung function (FEV1)
3. Improve oxygenation
4. Decrease risk of early relapse
5. Decrease treatment failure
6. Decrease length of hospitalization
How long do you need to do pulmonary rehab to get the optimum benefits of it? (range)
6-8 weeks, no added benefit with going up to 12 weeks
IMAGE CHALLENGE!!!
Which lobe is an ideal target for BLVR (1) and why (2 reasons, 1 point each)
Left lower lobe
Completeness of fissure and degree of heterogeneity
What is the basic criteria for referral to the multidisciplinary evaluation meeting? (think Quil :))
1. Diagnosed as severe COPD FEV < 50%
2. Signs of air trapping with TLC > 100%; RV > 150%
Which alpha-1 genotype is most likely associated with liver disease?
PiZZ
What percent of patients with AECOPD have a PE? (actual number, no range)
5.9 (Will accept range (+/- 2)
Name 5 things that improve mortality in COPD ( 1 point each)
1. Smoking cessation
2. Long term O2 therapy
3. NIV
4. LVRS
5. Triple therapy in high exacerbators
What is the most common complication of EBV and what is it's frequency? (number, not range)
Pneumothorax 26% (will accept +/- 5%)
What are the criteria to list a patient with COPD for lung transplant? (list all)
1. BODE > 7 + FEV1 < 15 - 20% + 3/more severe exacerbations/1 severe exacerbation with hypercapneic RF
2. Moderate to severe PH
What makes the BODE index and what does it predict? (1 point for each component)
The BODE index is scored on a point scale of 1-10 based on the following criteria: FEV1 % of predicted, 6-minute walk distance, mMRC scale, and BMI. The cumulative score is then correlated with 4-year survival.