1 - COPD/tobacco

Question 1

COPD is characterized by? what cells involved?

Answer 1

inflammation: neutrophils = driving force (vs asthma which is eosinophilic)

Question 2

COPD as a spectrum of pathology?

Answer 2

emphysema and chronic bronchitis

Question 3

what is emphysema

Answer 3

abnormal, permanent dilatation of airspaces distal to terminal bronchioles, accompanied by alveolar wall destruction without fibrosis

Question 4

pink puffers vs. blue bloaters

Answer 4

P = emphysema. B = chronic bronchitis

Question 5

pink puffers: who? why? cor pulmonale?

Answer 5

individuals with predominance of emphysema: they maintain normal O2/CO2 until late, so thin and cachetic since they’re expending so much energy. cor pulmonale occurs late.

Question 6

chronic bronchitis: how is it defined?

Answer 6

clinically: productive cough (>250 mL/day) for at least 3 months per year for 2 consecutive years, with air flow obstruction

Question 7

blue bloaters: who? why? cor pulmonale?

Answer 7

pathological process localized to bronchi, these ppl don’t do extra work so hypercapnic and hypoxemic, cor pulmonale develops early

Question 8

co morbidities of COPD? most will die from?

Answer 8

weight loss, muscle wasting/weakness, systemic effects like osteoporosis, anemia, depression, cardiac disease. most die of cardiac causes.

Question 9

diagnosis of COPD?

Answer 9

use symptoms (cough, sputum, dyspnea) with exposure to risk factors (tobacco, occupation, pollution, family hx) –> then do spirometry to confirm COPD

Question 10

genetics of COPD?

Answer 10

only 1/5 smokers develop COPD so there is some genetic susceptibility or resistance to COPD. some will develop emphysema, some get chronic bronchitis.

Question 11

only known genetic defect that leads to COPD? how?

Answer 11

A1AT deficiency: minimizes injury caused by proteolytic enzymes released by neutrophils. deficiency = can’t protect against it = COPD more likely

Question 12

who do we screen for A1At deficiency?

Answer 12

ppl with COPD >65 years, or with smoking history less than 20 pack years

Question 13

who should be screened for COPD?

Answer 13

smoker/ex smoker > 40 with: regular cough, regular phlegm, simple chores make them SOB, wheezing with exertion or at night, frequent colds that persist longer

Question 14

classification of impairment of lung function?

Answer 14

all have FEV1/FVC less than 0.7: then by % predicted to stage mild, moderate, severe or very severe

Question 15

X rays for diagnosing COPD?

Answer 15

not helpful. only thing related to hypertension: flattening of hemi diaphragm on lateral view

Question 16

objectives of COPD treatment

Answer 16

relieving symptoms, improve QoL, prevent/manage exacerbations

Question 17

approach to COPD management

Answer 17

smoking cessation/exercise/education + PRN short acting bronchodilators. then with increasing severity: long acting bronchodilators, pulmonary rehabilitation, inhaled corticost. with LABA, oxygen, then surgery

Question 18

3 non pharmacologic COPD therapies

Answer 18

vaccinations, smoking cessation, exercise/pulm. rehabilitation

Question 19

bronchidilators: what works better? what does it or not do?

Answer 19

long acting better, and better if you use early in disease course. doesn’t influence lung function but will relieve symptoms, improve exercise tolerance, and reduce rates of exacerbations

Question 20

use of inhaled corticosteroids in COPD?

Answer 20

not alone: used in combination with LABA –> decrease exacerbations but doesn’t change loss of FEV1