Professional Documents
Culture Documents
EDUCATIONAL OBJECTIVES
1. Provide education to patients regarding chronic obstructive pulmonary disease (COPD) and its
treatments
2. Individualize medications for COPD on the basis of patient needs, interests, and characteristics
3. Provide care consistent with the chronic care model to focus on prevention of exacerbations
5. Describe key aspects of medications used for the treatment of COPD such as clinical efficacy and
administration technique
Post-test/Rationale:
1. All of the following statements about chronic obstructive pulmonary disease (COPD) are TRUE,
except:
A. In COPD, the airways become narrow and damaged, making it difficult to breathe
Correct answer: B.
Rationale: Although cigarette smoking is a leading factor for COPD development, other factors may be
involved, including genetics, age, gender, affected lung growth during development and childhood,
occupational and environmental exposures, low socioeconomic status, asthma, bronchitis, and
respiratory infections.
2. According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2017 Report,
pharmacotherapy for the management of stable chronic obstructive pulmonary disease should be
A. Symptoms only
B. Risk for future exacerbations only
D. Symptoms, risk for future exacerbations, and forced expiratory volume in 1 second
Correct answer: C.
Rationale: The 2017 GOLD ABCD tool classifies patients according to their symptoms and risk for
exacerbations, which should guide pharmacotherapy. Previous versions of the GOLD ABCD tool
incorporated symptoms and risk for future exacerbations, as well as forced expiratory volume in 1 second.
3. Which of the following outcomes has not been associated with the use of inhaled medications
A. Reduction in symptoms
D. Reduction in mortality***
Correct answer: D.
Rationale: To date, pharmacologic therapies for the chronic management of stable chronic obstructive
pulmonary disease have been shown to reduce symptoms, reduce the risk and severity of exacerbations,
improve health status, and improve exercise tolerance. A reduction in mortality has not been observed.
4. Which of the following statements regarding the comparative efficacy of medications used in
A. Long-acting muscarinic antagonists (LAMAs) are associated with a reduced risk for COPD
B. LABAs are associated with a reduced risk for COPD exacerbations compared to LAMAs
C. Combination therapy with inhaled corticosteroids (ICS) and a LABA is as effective as combination
D. Combination therapy with ICS and a LABA is more effective than combination therapy with a LABA
Rationale: The Prevention of Exacerbations with Tiotropium in COPD (POET-COPD) study showed that
once-daily tiotropium (a LAMA) was more effective than twice-daily salmeterol (a LABA) at reducing the
risk of exacerbations in patients with moderate to very severe COPD and a history of exacerbations in the
Exacerbations (FLAME) trial showed that a LABA plus a LAMA was noninferior and superior to a LABA
The patient is a 60-year-old female with a past medical history of hypertension, type II diabetes mellitus,
and chronic obstructive pulmonary disease (COPD). She is classified as Group B, according to the
criteria in the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2017 Report. Her current
1000 mg by mouth twice daily, insulin detemir 20 units at bedtime, and a daily multivitamin. She received
her annual influenza vaccine but has never received any pneumococcal vaccines. She denies alcohol use
5. According to the GOLD 2017 Report, which of the following medication classes is initially
A. Short-acting beta2-agonist
Correct answer: C.
Rationale: According to the GOLD 2017 Report, initial therapy for GOLD Group B is a long-acting
bronchodilator. Either a LABA or a LAMA is recommended. Evidence does not support the use of one
current COPD regimen and an assessment of inhaler technique indicates appropriate skill.
Correct answer: D.
Rationale: According to the GOLD 2017 Report, patients with GOLD Group B disease who experience
7. The patients pharmacotherapy is escalated accordingly. She states that she prefers a once-
daily inhaler dosing regimen. Which of the following inhaled delivery devices accommodates her
preference?
A. Formoterol
B. Aclidinium bromide
C. Olodaterol/tiotropium***
D. Salmeterol/fluticasone
Correct answer: C.
Rationale: Formoterol is a LABA that is dosed twice daily. Aclidinium bromide is a LAMA that is dosed
twice daily. Olodaterol/tiotropium is a combination LABA plus LAMA that is dosed once daily.
8. Which of the following counseling points should be provided for the appropriately selected
D. To inhale the medicine take a quick, forceful, and deep breath in through your mouth
Correct answer: C.
Rationale: Olodaterol/tiotropipum is classified as a soft-mist inhaler (SMI). SMIs should not be shaken
prior to use (unlike pressurized metered-dose inhalers) and require the patient to take a slow, deep
9. According to the 2017 Immunization Schedule for Adults, which vaccination should be
Correct answer: B.
Rationale: The 2017 Immunization Schedule for Adults recommends that patients aged 19 through 64
years with COPD should receive PPSV23. The patient in this case is 60 years old. At age 65 years or
older, the patient should receive the pneumococcal conjugate vaccine (PCV13) and 1 more dose of
PPSV23 at least 1 year after PCV13 and at least 5 years after the most recent dose of PPSV23.
10. Which of the following patient-specific factors needs to be considered when selecting an
inhaled delivery device for the management of chronic obstructive pulmonary disease?
A. Cognitive function
B. Comorbidities
Correct answer: D.
Rationale: The 2017 Global Initiative for Chronic Obstructive Lung Disease Report emphasizes tailoring
inhaled therapy to the patients specific needs. For example, the patients cognitive function,
comorbidities, dexterity, and strength must be considered, as each inhaled delivery device has
advantages and disadvantages for use. In addition, the medications availability, cost, and reimbursement