Asthma/COPD Patho Flashcards
COPD
Preventable, common, Treatable
Persistent Respiratory symptoms and airflow limitation
Caused by exposure to noxious particles or gases
Exacerbation and Cormobidities contribute to severity.
ONCE DEVELOPED, CANNOT BE CURED
Factors that Influence COPD
Particle exposure, Genes, asthma, lung growth/development, age/gender, infections, Socioeconomic status.
Inflammatory Cells
Neutrophils, Macrophages, CD8 lymphocytes
Release inflammatory mediators and interact with the structural cells in airways and lung parenchyma.
Inflammatory Mediatiors
TNF alpha, Interleukin 8 and leukotriene B4
Attract inflammatory cells from circulation, amplify inflammatory process, induce structural changes
Protease break down
Increase proteases in COPD Patients from inflammatory and epithelial cells.
Protease Destruction of elastin
Major connective tissue in lung parenchyma
Peripherial Airway Limitation
Reduces inspiratory capacity. Dyspena/ limitation of exercise capacity and reduction in lung volumes. Correlated with forced expiratory volume.
Physiologial abnormalities/ symptoms of COPD
Gas exchange abnormalities
Possible low oxygen in blood (hypoxemia) and increased CO2 in blood (Hypercapnia)
Mucus Hypersecretion
Increased goblet cells and enlarged submucosal glands
Pulmonary Hypertension
Vasoconstriction of small pulmonary arteries
may lead to right ventricular hypertrophy and then to right side cardiac failure.
concomitant chronic diseases of COPD
Skeletal muscle wasting Osteoporosis Anemia CVD Diabetes Metabolic syndrome
Exacerbations of COPD
Triggers (Infections and enviornmental pollutants)
Increased Inflammation
Dyspnea, Hypoxemia
Increased hyperinflation and gas trapping
Goals of COPD management
Prevent disease progression § Relieve symptoms § Improve exercise tolerance § Improve health status § Reduce exacerbations § Reduce mortality § Prevent or minimize side effects from treatment
Treatment of COPD Pharm and NONpharm
Helps to get exercise
Pulmonary Rehab which includes groups B-D
Vaccines
Group A COPD
Bronchodilator
Group B COPD
Long acting Bronchodilator
Group C COPD
Long acting anticholinergic
Group D COPD
Long acting anticholinergic +/- Long acting Beta 2 agonist
Or
Long acting Beta 2 agonist+/- inhaled corticosteroid
Does long term oxygen been shown to help?
Yes with pts with severe resting hypoxemia greater than 15 hours per day
Death By COPD
CVD, Lung cancer, and respiratory failure
Asthma definition
Chronic inflammatory Disorder that involves interactions between host and environment
Host factors for asthma
Genes, Obesity, gender, and early growth characteristics
Enviornmental Exposures to Asthma
Allergens • Occupational sensitizers • Infections • Socioeconomic inequalities • Exposure to tobacco smoke • Air pollution • Diet • Stress
Asthma Pathophysiology
Inflammation causes recurrent episodes of wheezing, SOB, Breathlessness, chest tightness and coughing.
Inflammation causes Bronchial Hyperresponsivenes and can lead to airway obstruction.
Mast Cells Asthma
Release bronchoconstrictor mediatiors
Cysteinyl leukotrienes histamine, PGD2
Eosinophils Asthma
Increased numbers of the cells in airways of most people with asthma. Possible marker
Neutrophils Asthma
Increased numbers of cells in airways and sputum with severe asthma and pts with asthma that smoke
Airway narrowing Asthma
Smooth Muscle Contraction
Response to Bronchoconstrictor mediators. reversed by bronchodilators
Airway edema
Micro vascular leakage in response to inflammatory mediators.
Bronchial Hyperresponsiveness
Exaggerated Bronchoconstriction response to stimuli that is innocuous to a healthy person.
Used to diagnose asthma
Inflammation is a major factor in determining the degree of airway hyperresponsiveness
Airway remodeling
Possibly an irreversible process.
Thickening of sub-epithelial reticular BM
Increase in airway smooth muscle mass
mucus gland hyperplasia and hypersecretion.
Nitric Oxide
Produced in the respiratory tract
Induced in pro inflammatory cells
amplifies inflammatory process
Useful measurement of ongoing lower airway inflammation
