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SDK125 > 5. COPD > Flashcards

5. COPD Flashcards

1
Q

What’s the long word for COPD?

A

Chronic obstructive pulmonary disease

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2
Q

What means ‘pulmonary’?

A

‘Of the lungs’

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3
Q

COPD is a result of damage to the lungs caused by…

A

… long-term exposure to inhaled particles of smoke, dust, or fibres and sometimes noxious gases.

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4
Q

Name the most important sources sources of exposure to dust, smoke or gases in Europe and Africa.

A

In developed regions such as Europe, tobacco smoking is the main source of inhaled smoke particles that cause ill health.

In developing regions such as Africa, a more important source is indoor smoke pollution from the burning of solid fuels for cooking and heating.

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5
Q

People with COPD usually have a combination of two conditions. Which are they?

A

Chronic bronchitis and emphysema.

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6
Q

What happens in the lungs when someone is affected by chronic bronchitis?

A

In chronic bronchitis the airways become inflamed and their walls thicken, so that the passage down the middle narrows.

The damaged airways also produce a lot of thick, sticky mucus which causes frequent coughing.

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7
Q

What happens in the lungs when someone has emphysema?

A

In emphysema the walls of the air sacs break down and the lungs become floppy and less elastic, affecting their ability to transfer gases into and out of the body.

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8
Q

Can the damage to the lungs by COPD become cured?

A

No. The damage caused to the lungs is irreversible, and the condition is progressive; that is, the damage gradually accumulates and the symptoms worsen.

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9
Q

What is ‘sputum’?

A

Sputum is matter that is coughed up from the lungs and airways and is composed of mucus (a viscous secretion produced by the linings of the nose, throat and lungs), mixed with saliva.

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10
Q

What is a spirometry and how does it work?

A

A spirometry is a lung function test. It measures the rate at which an individual is able to force air out of their lungs.

The airflow through the lungs of people with COPD is obstructed by the damage to their lungs, so these individuals will only be able to force air out of their lungs at a reduced rate compared with a person with healthy lungs.

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11
Q

What are particulates?

A

Fine particles of a solid suspended in the air. Health and safety legislation in many countries requires that smoky or dusty working environments and areas with heavy traffic or pollution are regularly monitored for the concentrations of toxic gases and small particulates known as PM10 (pee-em-ten). These are particles with a diameter of less than 10 μm.

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12
Q

In many developing countries, there are high levels of COPD even when tobacco smoking is rare. Why?

A

Clean fuels for cooking and heating, particularly electricity, are expensive and half of the world’s population (around 3 billion people) instead rely on coal, an impure fossil fuel extracted from the ground by mining, or biomass fuels derived from plant material or animal waste (including wood, dried animal dung, crop residues or charcoal).

Many people are therefore regularly exposed to very high levels of indoor smoke.

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13
Q

Does outdoor air pollution increase the risk of developing respiratory diseases such as COPD?

A

No, there is no strong evidence to prove that, so this topic is quite controversial. Of course it can still be dangerous though, especially for people who already have respiratory diseases.

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14
Q

What kind of organisms are humans and bacteria (cells)?

A

Bacteria are single-celled; humans are multicellular.

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15
Q

What is cellular respiration?

A

The chemical reactions that take place in the individual cells of all organisms to release energy from nutrients.

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16
Q

The reaction of molecules with oxygen is called…

What is it needed for?

A

Oxidation.

The chemical energy released is required to power cellular processes, for example the contraction of muscle cells during body movement, or the manufacture of proteins by all types of cell.

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17
Q

What are the mitochondria?

A

Mitochondria are small ‘engines’ in cells, where the cellular respiration takes place. They need a constant supply of oxygen for this process.

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18
Q

Can you think of a reason why you cannot simply exchange gases through your body surface like a bacterium?

A

The human body is covered in a protective tissue, the skin, that acts as a barrier, containing and protecting our internal organs and tissues against infection and dehydration. It isn’t very permeable to fluids or gases.

Another reason is that the surface area of the body is small in comparison to its volume and by the simple process of diffusion, gases wouldn’t penetrate very far into the body. It wouldn’t be possible to supply the cells deep inside the body with oxygen.

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19
Q

Human respiration can be divided into five steps:

A
  1. ventilation which brings air into the lungs (and expels air containing waste carbon dioxide)
  2. exchange of respiratory gases between the lungs and the blood
  3. transport of respiratory gases around the body in the blood
  4. exchange of respiratory gases between the blood and the body tissues
  5. cellular respiration (the release of chemical energy from nutrient molecules by oxidation in the individual cells of body tissues)
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20
Q

The medical term for throat?

A

Pharynx

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21
Q

Speiseröhre in english?

A

Oesophagus

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22
Q

There are two openings in the throat, one leading to…

A

… the oesophagus and the digestive system and the other to the voice box (Kehlkopf) or larynx and the rest of the respiratory system.

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23
Q

What is the diaphragm?

A

The muscular diaphragm separates the chest cavity from the abdominal cavity.

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24
Q

From the larynx, air passes into…

A

… trachea, a wide hollow tube about 2 cm in diameter that is held permanently open by semicircles of a tough connective tissue called cartilage (Knorpel).

The trachea divides into two branches called bronchi, which serve the left and right lungs.

Each bronchus divides into two smaller bronchi which divide again and again, forming a series of increasingly smaller bronchi, and then even smaller bronchioles that are less than 1 mm in diameter

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25
Q

The bronchioles at the tips of the bronchial tree open into tiny air sacs (bag-like structures) called…

A

alveoli (singular: alveolus)

The walls of the alveoli are only a single-cell thick and are the respiratory surface where oxygen diffuses into the body.

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26
Q

Describe the process in the alveoli.

A
  1. Gases, including oxygen, in the air inside the alveoli dissolve in the film of moisture on the surface of the alveolar wall
  2. They diffuse across into very small blood vessels called capillaries inside the lung tissue
  3. The waste gas carbon dioxide can diffuse in the other direction from the pulmonary capillaries into the alveoli so that it can be exhaled
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27
Q

The process of breathing starts in the brain in…

A

the respiratory centres in a brain region called the medulla.

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28
Q

The respiratory centres send a series of… in order to…

A

They send a series of action potentials along nerves which stimulate the muscular diaphragm and the muscles between the ribs (the intercostal muscles) to contract.

29
Q

Destruction of alveolar walls in emphysema has two effects:

A
  1. It reduces the area of contact between the alveoli and the blood capillaries across which gases can diffuse
  2. It reduces the elasticity of the lungs
30
Q

The oxygen-carrying capacity of blood is facilitated by a carrier molecule called…

A

haemoglobin

31
Q

The red blood cells are called…

A

erythrocytes

32
Q

Haemoglobin can be found where?

A

In erythrocytes (red blood cells)

33
Q

Haemoglobin with oxygen bound is called…

A

oxyhaemoglobin

34
Q

Describe the structure of an haemoglobin molecule.

A

It is made of four proteins called globins, each folded around a molecule called haem.

Each of the four haem molecules holds at its centre an atom of iron (Fe), which is able to form a bond with one oxygen molecule, so that one complete haemoglobin molecule can carry four oxygen molecules at once.

35
Q

Blood containing a large proportion of oxyhaemoglobin is referred to as…

A

oxygenated blood

36
Q

What happens when the oxygenated blood circulates into blood capillaries in tissues where the PO2 is very low?

A

The oxyhaemoglobin separates or dissociates, into haemoglobin and free oxygen molecules. The oxygen then diffuses into the tissues.

37
Q

What happens when carbon monoxide ‘meets’ haemoglobin?

A

Carbon monoxide binds to the haem part of haemoglobin (like oxygen), but it binds irreversibly, forming carboxyhaemoglobin.

Carboxyhaemoglobin can no longer bind to oxygen because the carbon monoxide has permanently occupied the oxygen bonding sites.

38
Q

Can you suggest why climbers are in danger of experiencing hypoxia at very high altitudes?

A

The partial pressure of oxygen in the atmosphere is lower at high altitude than at sea level. The oxygen concentration is lower, so the concentration gradient between the atmospheric air and the blood will not be very great.

During an inspiration, fewer oxygen molecules will diffuse from the lungs into the blood.

39
Q

A condition where all or part of the body is deprived of oxygen, whether through the effects of low oxygen in the atmosphere, toxic gases such as carbon monoxide, or defects in the respiratory system, is called…

A

hypoxia

40
Q

The oxygenated blood from the lungs enters which part of the heart? And what happens then?

A

The oxygenated blood enters the left atrium and is pumped out of the left ventricle into the system of blood vessels called arteries that carry it to the body tissues.

41
Q

What happens with the oxygen-depleted blood that has passed through the tissues?

A

The oxygen-depleted blood is transported back to the heart through blood vessels called veins.

It enters the heart at the right atrium, and is pumped out of the right ventricle via the pulmonary artery and off to the lungs where oxygen is replenished.

42
Q

How does the body match the requirement for oxygen with supply to the tissues?

A

By chemoreceptors, which are groups of cells that convert chemical signals into action potentials that travel along nerves.

These receptors are everywhere in the body, feeding information to the respiratory centres in the brain, which in turn send out signals to the diaphragm and rib muscles to contract at an appropriate rate.

43
Q

Why does blood PCO2 increase during strenuous exercise?

A

Exercise increases the requirement for cellular respiration to provide the necessary energy for muscle contraction.

More of the products of cellular respiration (carbon dioxide and water) are therefore produced by the tissues.

44
Q

What happens when epinephrine is released?

A
  1. it stimulates an increase in the force and rate of the heartbeat
  2. it causes the blood capillaries in the skeletal muscles to widen, or dilate, so that more blood flows into the muscles, helping to deliver oxygen more quickly
45
Q

What would happen to the muscles during exercise if the supply of oxygen could not be increased?

A

The muscles would not be able to generate enough energy to sustain rapid contractions for very long, and they would become fatigued.

46
Q

Another consequence of the complex response of the body to low oxygen and high carbon dioxide levels is that the body has constricted (narrowed) the blood capillaries in her lungs to slow down the flow of blood through her lungs.

Can you suggest why this might help to alleviate the shortage of oxygen in the damaged lungs and help to combat hypoxia?

A

Slowing the flow of blood through the pulmonary capillaries gives more time for the erythrocytes to pick up oxygen molecules that do diffuse through the alveolar walls.

This helps to keep the PO2 of the circulating blood a little bit higher so that it delivers oxygen to the tissues more efficiently.

47
Q

Blood ‘backing up’ towards the right ventricle of the heart creates…

A

pulmonary hypertension, meaning very high blood pressure pressing against the walls of the pulmonary artery.

48
Q

High blood pressure is a sign for what happening somewhere in the body?

A

It’s a sign that somewhere in the body the passage of blood through the circulation is impeded.

49
Q

What is acidic and basic?

A

Acidic: dissolved in water releasing H+ ions,

lower the blood pH below 7

(the hydrogen ion concentration in any solution determines how acidic it is)

Basic: dissolved in water releasing OH- ions,

increase the blood pH over 7

(basic solutions/bases are also called alkalis)

50
Q

What is acidosis?

A

A condition where the body’s overall pH starts to drop below 6.8. This is very dangerous, as most of the chemical reactions that occur in the body, especially those involving enzymes, only take place in conditions of neutral pH (around pH 7).

51
Q

What happens with the carbon dioxide generated by cellular respiration?

A

It reacts with water in the erythrocytes, through the action of the enzyme carbonic anhydrase, to form bicarbonate ions and hydrogen ions, which are carried back to the lungs and converted back to water and carbon dioxide.

The carbon dioxide diffuses into the lung alveoli and is expelled during expiration.

52
Q

COPD reduces the ability to expel carbon dioxide by expiration.

What happens then in the blood?

A

The hydrogen ions build up in the blood, lowering its pH and causing acidosis.

53
Q

What is inflammation?

A

Inflammation is the first response of the body to wounds, infection or irritation, and it is characterised by redness, heat, swelling and sometimes pain in the affected area.

It is an essential part of the normal process of healing and protecting wounds.

However, if inflammation is sustained for long periods, it can have disastrous consequences for body tissues.

54
Q

What is the other name for white (blood) cells?

A

leukocytes

55
Q

The damaged cells in a wound or in lungs irritated by smoke or dust release a range of different chemicals and proteins called…

A

inflammatory mediators

56
Q

What are the first leukocytes to arrive at a wound?

A

Phagocytes. They attach to microbes or other small particles and completely engulf them. Once inside the phagocyte, the particle is broken down by powerful digestive enzymes.

57
Q

What happens when large numbers of phagocytes are attracted to the lungs due to the particles and toxins sticking to the walls of the small airways and alveoli?

A

They release powerful protein-digesting enzymes called proteinases.

58
Q

What are proteinases doing in the lung?

A

They normally digest any microbes or particles engulfed by these cells, but if the enzymes leak into the surrounding tissues, they can begin to digest the proteins in the lung tissues as well.

59
Q

One of the major culprits of the proteinases in the lungs is an enzyme called…

What does it do then?

A

elastase, which phagocytes normally use to break down proteins in the cell walls of bacteria.

Unfortunately elastase, as its name suggests, also breaks down a body protein called elastin, which is used in the lung as a component of the connective tissue fibres that give elasticity to the walls of the airways and alveoli and so aids expiration of air.

60
Q

What is alpha-1 antitrypsin?

A

The body’s own natural elastase inhibitor, also called AAT.

It is produced by the liver and circulates through the body in the blood.

61
Q

What is the FEV1?

A

FEV1: forced expiratory volume over 1 second

62
Q

What happens during a gas transfer test?

A

This measures the efficiency of the second stage of respiration; that is, how well gas passes from her lung alveoli into the blood.

She inhaled air containing a known small and safe amount of carbon monoxide, some of which diffuses into the blood and binds tightly to haemoglobin molecules. She then exhaled into a machine that measured the carbon monoxide remaining in the air that she exhaled.

63
Q

Jenny has emphysema – so will there be more or less carbon monoxide left in the air she exhales at the end of a gas transfer test, compared with someone with healthy lungs?

A

In emphysema, many of the alveolar walls have been destroyed, so Jenny’s lungs effectively have a lower surface area, reducing her ability to transfer gases from her lungs into her blood.

Therefore there will be more carbon monoxide remaining in the air that she exhales, compared with a person with healthy lungs taking the test.

64
Q

Which two methods can be used to measure the levels of oxygen and carbon dioxide in the blood?

A
  1. arterial blood gas test (ABG test)
  2. pulse oximetry
65
Q

Why might some COPD patients experience panic attacks when they attempt to become more active?

A

Changes in blood gases trigger hyperventilation, and the increased effort of breathing can itself trigger anxiety and the release of epinephrine.

66
Q

What are bronchodilators?

A

These drugs have a very similar ‘shape’ to adrenaline, and can bind to its receptor and trigger the same response in cells – including dilation of the airways. They help to relieve constriction of the bronchioles during asthma attacks, so they are called bronchodilators or ‘relievers’.

67
Q

What are anti-inflammatories?

A

A class of drugs that suppress the activity of the immune system.

68
Q

What is pulmonary rehabilitation?

A

Pulmonary rehabilitation is a multidisciplinary approach to managing COPD that aims to break the cycle of worsening breathlessness, reduced physical activity and muscle de-conditioning.

SDK125 (7 decks)

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