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CTB Block 2 > B2 W2 - Pathophysiology and Clinical Aspects of Chronic Obstructive Pulmonary Disease (COPD) > Flashcards

B2 W2 - Pathophysiology and Clinical Aspects of Chronic Obstructive Pulmonary Disease (COPD) Flashcards

1
Q

What is COPD?

A

COPD, or Chronic Obstructive Pulmonary Disease, is an umbrella term that refers to:

  • chronic
  • mostly irreversible,
  • obstructive

airway changes.

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2
Q

What conditions are included under the umbrella term COPD?

A
  • Chronic bronchitis
  • Emphysema
  • Some older patients with chronic asthma and asthma-COPD overlap syndrome (“ACOS”).
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3
Q

What is the most common cause of COPD?

A

Smoking is overwhelmingly the most common cause of COPD.

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4
Q

What is the difference between chronic bronchitis and emphysema?

A
  • Chronic bronchitis is a disease of the larger airways (bronchus, larger bronchioles)
  • Emphysema affects the smaller airways (smaller bronchioles, alveoli).
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5
Q

What are the symptoms of chronic bronchitis?

A

Chronic bronchitis typically causes a chronic, productive cough due to inflammation, mucus gland hypertrophy & hyperplasia, and hypersecretion of mucus in the larger airways.

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6
Q

What are the symptoms of emphysema?

A

**Shortness of breath (dyspnoea) ** due to alveolar wall destruction and air space enlargement, which results in a reduced gas exchange surface area.

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7
Q

What are the reversible causes of airflow obstruction in COPD?

A
  • Bronchoconstriction (Smooth muscle contraction)
  • Inflammation
  • Mucus plugging.
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8
Q

What are the irreversible causes of airflow obstruction in COPD?

A
  • Airway remodelling (Chronic Bronchitus)
  • Alveolar Wall destruction - loss of lung elasticity (Emphysema)
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9
Q

What are the common symptoms of COPD?

A

Patients with COPD most commonly present with

  • a productive cough (sputum)
  • wheeze
  • breathlessness (dyspnoea)
  • frequent infective exacerbations with purulent sputum.
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10
Q

What are the common signs of COPD?

A
  • Difficulty Completing Sentences
  • High Respiratory Rate (Tachypnea)
  • High Heart Rate (Tachycardia)
  • Audible Wheeze
  • Cyanosis
  • Barrel Chest
  • Use of Accessory Muscles
  • Oedema
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11
Q

What is the key investigation for diagnosing COPD?

A

Spirometry is the key investigation for diagnosing patients with COPD.

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12
Q

What spirometry result confirms a diagnosis of COPD?

A

A diagnosis of COPD requires a reduced FEV1:FVC ratio below 0.7.

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13
Q

What other investigations can be used in the diagnosis of COPD?

A
  • Chest X-ray
  • Arterial blood gas
  • Haemoglobin.
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14
Q

What is the most important aspect of care for someone with COPD?

A

Stopping smoking is by far the most important aspect of care for someone with COPD.

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15
Q

What is the overarching principle of treatment for COPD?

A

The overarching principle of treatment for COPD is that most treatments are symptomatic; they may improve symptoms, but rarely do much to improve the underlying condition.

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16
Q

Name some classes of drugs commonly used in the management of COPD.

A
  • Bronchodilators
  • Anti-Inflammatory Agents
  • Combination therapies
  • Oral theophylline
  • Mucolytic agents.
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17
Q

Besides medication, what other aspects of chronic COPD care can be considered?

A

In addition to medication, aspects of chronic COPD care include
* smoking cessation
* education
* self-management strategies
* action plans
* immunisation
* pulmonary rehabilitation & exercise
* nutrition & weight management
* long-term oxygen therapy
* home nebulisation
* psychological issues,
* risk reduction from other cardiac & respiratory diseases
* social & occupational therapy support
* end-of-life care.

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18
Q

How are acute exacerbations of COPD managed in the community setting?

A

increasing the use of inhalers/nebulisers, corticosteroids, and antibiotics.

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19
Q

How are acute exacerbations of COPD managed in the hospital setting?

A

Management of acute exacerbations of COPD in the hospital setting includes:

  • nebulisers
  • oxygen
  • IV aminophylline
  • IV antibiotics
  • IV steroids
  • chest physiotherapy
  • ITU/assisted ventilation.
20
Q

What are the key differences between the pathophysiology of asthma and COPD?

A
  • The type of inflammation
  • The cells involved
  • The reversibility of airflow obstruction
  • The structural changes in the airways.
21
Q

What percentage of older smokers have COPD changes in their lungs?

A

Around 50% of older smokers (those who have smoked for more than 20 years) have COPD changes present in their lungs.

22
Q

Besides smoking, what other factors can contribute to the development of COPD?

A
  • Exposure to other pollutants
  • α1-antitrypsin deficiency.
23
Q

How should chronic bronchitis and emphysema be viewed in relation to COPD?

A

It is better to think of an individual with COPD as being on a spectrum of chronic bronchitis and emphysema, with most people having a combination of both conditions to varying degrees.

24
Q

What are the specific inflammatory and structural changes seen in chronic bronchitis?

A

Chronic bronchitis involves:

  • Squamous metaplasia of the epithelium
  • Goblet cell and submucosal gland hyperplasia
  • Infiltration of the airway wall with macrophages and CD8+ T-lymphocytes,
  • Neutrophils in the airway lumen and around submucosal glands
  • Peribronchial fibrosis
  • Potential increase in airway smooth muscle
25
Q

How can medication be used to target reversible causes of airflow obstruction in COPD?

A

Medications can be used to:

  • Relax smooth muscle (e.g., bronchodilators)
  • Reduce inflammation (e.g., corticosteroids)
  • Thin mucus (e.g., mucolytics)

to improve airflow obstruction.

26
Q

Historically, what terms were used to describe patients at opposite ends of the COPD spectrum, and why are these terms no longer considered appropriate?

A
  • “Pink puffers” and “blue bloaters” were historically used to describe patients with predominantly emphysematous changes and predominantly chronic bronchitis changes, respectively.
  • However, these terms are outdated and inappropriate because most patients have a mix of both conditions, and they reinforce stereotypes that are not always accurate.
27
Q

In what specific situation are arterial blood gases used in COPD assessment?

A

During acute exacerbations of COPD to help guide oxygen therapy.

28
Q

Why is a chest X-ray important in the initial assessment of suspected COPD?

A

A chest X-ray is crucial to rule out lung cancer, which is important because patients with suspected COPD often have a significant smoking history and are therefore at higher risk of lung cancer.

29
Q

What are the key differences between the clinical presentation of asthma and COPD?

A
  • Asthma typically presents in childhood with intermittent symptoms, a good response to bronchodilators, normal spirometry between exacerbations, and no smoking history.
  • COPD typically presents in older adults with chronic symptoms, a less dramatic response to bronchodilators, persistently abnormal spirometry, and often a history of smoking.
30
Q

What are the reasons for the increase in COPD deaths globally between 2000 and 2016?

A

There are several contributing factors.

  • Deaths from lower respiratory infections have significantly decreased due to better treatments; however, smoking rates have increased in Asia and Africa.
  • Additionally, pollution continues to be a problem in some areas.
  • Finally, COPD is often underdiagnosed, especially in healthcare systems where infectious diseases are a more immediate concern.
31
Q

Why don’t all smokers develop COPD?

A
  • Only 10-20% of smokers develop clinically significant COPD.
  • This suggests that genetic and/or epigenetic factors might influence a person’s susceptibility to the harmful effects of cigarette smoke.
32
Q

What does the FEV1:FVC ratio reveal about lung function and how is it relevant to COPD?

A
  • A reduced FEV1:FVC ratio means that a person, compared to someone with the same lung capacity (FVC), can exhale less air in one second (FEV1).
  • This points towards an obstructive airway problem, a key characteristic of COPD.
  • This is different from restrictive lung diseases, like pulmonary fibrosis, where lung capacity itself is reduced.
33
Q

How does smoking cessation impact life expectancy in COPD patients?

A
  • Stopping smoking is the single most important factor in improving life expectancy for individuals with COPD, often by several years.
  • Research by Fletcher & Peto from the 1970s showed that while FEV1 naturally declines with age, the decline is much faster in smokers after the age of 45-50.
  • However, quitting smoking at any point can improve a patient’s prognosis.
34
Q

What is asthma-COPD overlap syndrome (ACOS)?

A
  • ACOS refers to patients who have features of both asthma and COPD.
  • These patients are often older adults with a history of asthma who develop fixed airflow obstruction, similar to COPD.
35
Q

How does the presence of lymphoid follicles differ in severe COPD compared to asthma?

A
  • In severe COPD, lymphoid follicles are present in the airway walls.
  • This feature is not typically seen in asthma.
36
Q

Apart from smoking cessation, what other lifestyle interventions are important in COPD management?

A

Other important lifestyle interventions include:

  • Education
  • Self-management strategies
  • Action plans
  • Immunisation (particularly against influenza and pneumonia)
  • Pulmonary rehabilitation and exercise
  • Optimising nutrition and weight management.
37
Q

When are oral corticosteroids like prednisolone used in COPD management?

A

In the management of acute exacerbations of COPD, particularly in the community setting.

38
Q

What is the role of chest physiotherapy in the management of acute COPD exacerbations?

A
  • Chest physiotherapy is employed in hospital settings during acute exacerbations of COPD.
  • It helps to clear mucus from the airways and improve lung function.
39
Q

What are the differences in the typical inflammatory cells involved in asthma and COPD?

A
  • Asthma is characterized by eosinophils and mast cells as the primary inflammatory cells.
  • In contrast, COPD typically involves neutrophils, macrophages, and CD8+ T lymphocytes.
40
Q

What are the differences in the reversibility of airflow obstruction in asthma and COPD?

A
  • Airflow obstruction in asthma is largely reversible with bronchodilators.
  • However, airflow obstruction in COPD is partially reversible at best, as there is significant structural damage to the airways and lung parenchyma.
41
Q

Besides bronchodilators, what other classes of drugs are commonly prescribed for COPD?

A
  • Inhaled corticosteroids
  • Oral theophylline (only when other bronchodilators are ineffective or inappropriate)
  • Mucolytic agents.
42
Q

In which specific cases is weight loss a common symptom in COPD?

A

In advanced COPD, particularly in those with a predominant emphysema phenotype, weight loss can occur due to the high energy expenditure required for breathing and the loss of appetite.

43
Q

Explain the pathophysiolgy behind dyspnea (breathlessness) in COPD.

A
  • This is primarily due to the impaired gas exchange in emphysema and the increased work of breathing caused by airflow obstruction.
  • It can occur with exertion or even at rest in severe cases.
44
Q

What is wheezing and explain ir’s pathophysiolgy in COPD.

A
  • Wheezing is a high-pitched whistling sound that occurs during breathing, usually on exhalation.
  • It is caused by narrowed airways and airflow obstruction, a hallmark of both chronic bronchitis and emphysema.
45
Q

What is cor pulmonale?

A

Right-sided heart failure

CTB Block 2 (19 decks)

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