286 COPD Flashcards
Major risk factor for mortality in COPD
Cigarette
Most significant predictor of FEV1
Cigarette smoking
Leads to exacerbation
Respiratory infection
True or false. Ambient air pollution is a risk factor for COPD
False. Not proven yet. But can trigger exacerbation
Spectrum of COPD
Pink puffer: emphysema dominant
Blue bloater: bronchitis dominant
Reasons for cachexia in COPD
Inadequate intake and elevated level of TNF alpha
Pulmonary test result in COPD
FEV1 dec
FEV/FVC dec
Lung volume RV inc
DLCO (emphysema) dec
Classification of COPD based on severity
GOLD 1 FEV1 more than 80
GOLD 2 less than 80
GOLD 3 50
GOLD 4 less than 30
Therapy proven to improve survival in COPD
Smoking cessation
Oxygen therapy
Lung reduction surgery
Nicotine replacement used in COPD
Bupropion
Varenicline
Primary treatment for almost all patients with COPD
Bronchodilators
Common side effect of anticholinergic muscarinic antagonist
Dry mouth
Acute improvement in lung function
SABA
For symptomatic relief in long term and reduce exacerbations
LABA
Side effects of beta agonist
Tremors and tachycardia
Main role of inhaled corticosteroids
Reduce exacerbations
Side effects of inhaled corticosteroids
Oropharyngeal candidiasis
Side effects of oral glucocorticoids
Osteoporosis
Only pharmacologic therapy shown to decrease mortality rate
Oxygen therapy
True or false. COPD is the second leading indication for lung transplantation
True.
Strongest single predictor of COPD exacerbation
Previous exacerbation
Defined as acute worsening of respiratory symptoms
Exacerbation
True or false. PFT is not helpful during exacerbation in COPD compared to asthma
True
Potential indications of hospitalization for COPD
Acute respiratory failure
Treatment in COPD exacerbation
Bronchodilators
Systemic glucocorticoids
Antibiotics
Supplemental O2
Common pathogen leading to exacerbation in COPD
Strep pneumo
H influenza
M. Catarrhalis
Volume of air exhaled within the first second of forced expiration
FEV1
Total volume of air exhaled during the entire maneuver
FVC
Treatment for Group A
SABA
True or false. Mortality benefit equals number of hours per day on oxygen
True
True or false. Influenza vaccine yearly can reduce serious illness and death in COPD
True
True or false. PPSV23 reduced incidence of CAP in COPD less than 65 years old
True
True or false. PCV13 reduces bacteraemia and invasive pneumococcal disease more than 65 years old
True.
True or false. ICS is withdrawn in stable patient
True
Goals of therapy of COPD
Provide symptomatic relief Reduce further risk - prevent disease progression - prevent and treat exacerbation - reduce mortality
defined as a disease state characterized by persistent respiratory symptoms and airflow limitation that is not fully reversible
Chronic obstructive pulmonary disease
Anatomically defined condition characterized by destruction of the lung alveoli with air space enlargement
emphysema
clinically defined condition with chronic cough and phlegm
chronic bronchitis
what makes up COPD
emphysema, chronic bronchitis and small airway disease
condition in which small bronchioles are narrowed and reduced in number
small airway disease
a major physiologic change in COPD that can result in small airway disease and or emphysema
airflow limitation
hallmark of advanced COPD
fibrosis, and extensive small airway destruction
remains a prevailing mechanism for the development of emphysema
elastase:antielastase hypothesis
key component of COPD pathobiology
Oxidative stress
major regulator of oxidant-antioxidant balance in COPD
NRF2
potent antioxidant, have been implicated in emphysema pathogenesis
SOD3
True or false. Mitochondrial dysfunction in COPD may worsen oxidative stress
True.
subjects at greatest risk of progression in COPD
those with both aggressive airway disease and emphysema
Gold Stage I. What is the spirometry
FEV1 more than 80
Gold Stage II. What is the spirometry
FEV1 more than 50
Gold Stage III. What is the spirometry
FEV1 more than 30
Gold Stage IV. What is the spirometry
FEV1 less than 30
major site of increased resistance in most individuals with COPD
airways ≤2 mm diameter
distinct pathologic types of emphysema
centrilobular,panlobular, paraseptal
most frequent type of emphysema associated with cigarette smoking
centrilobular
type of emphysema most prominent in the upper lobes and superior segments of lower lobes and is often quite focal
centrilobular
emphysema characterized as abnormally large air spaces evenly distributed within and across acinar units panlobular
panlobular
Panlobular emphysema is commonly observed in patients with
α1AT deficiency
type of emphysema that occurs in 10–15% of cases and is distributed along the pleural margins with relative sparing of the lung core or central regions
paraseptal
most typical finding in COPD
Persistent reduction in forced expiratory flow rates
accounts for essentially all of the reduction in Pao2 that occurs in COPD;
Ventilation-perfusion mismatching
major risk factor for mortality from chronic bronchitis and emphysema.
cigarette smoking
most highly significant predictor of FEV1
Pack-years of cigarette smoking
allele is associated with normal α1AT levels
M allele
associated with slightly reduced α1AT levels
S allele
associated with markedly reduced α1AT levels,
Z allele
Percent COPD patients are found to have severe α1AT deficiency
1.00%
