B3- Copd

Question 1

What is rhe biggest risk factor of cood

Answer 1

Genetic suscetibility of smoking (not everyone gets copd from smoking but 50%)

Question 2

Give some stats

Answer 2

In 2002 was 5th leading seath cause

Preficted by 2030 to be 3rd leading cause of death

Affects 10% of european popn

Costs nhs 800 mill a year

Question 3

Who talks about the fev and fvc in copd

Answer 3

Johns et al 2014

Question 4

Why does fev lower

Answer 4

2mm narrowing in copd = obstruction

Question 5

What does fev1 drop to

Answer 5

80% in mild copd vs 30% in severe

Question 6

What is the fev1/fvc ratio to diagnose copd

Answer 6

Below 0.7

Question 7

What are the 2 pathologies of copd

Answer 7

Chronic bronchitis /airway obstructuon

Emphysema / lack of gas exchange

Question 8

What is chronic bronchitis (kim et al 2013)

Answer 8

Marrowing by 2mm due to infoammation and mucous metaplasia

Question 9

What % does it affect

Answer 9

14-74% of copd

Question 10

What increased risk does smoking give on cb

Answer 10

42%

Question 11

What sorts of things cause mucous metaplasiab (kim 2013)

Answer 11

Inflammatory cells eg th1,th17, neutrophilic oxidative stress, chronic infections and cigarette smoke

Question 12

How does smoke increqse mucous

Answer 12

Hyperplasia of goblet cells (as well as infections)

Question 13

What inside neutrophils eg if degranulated by smoke causes mucus metapladia

Answer 13

Neurrophil elastase

Question 14

What causes reduced elimination of the mucus (kim 2013)

Answer 14

Damaged cilia, weak respiratory muscles, low peak expiratory volume (narrowing)

Question 15

What is emphysema

Answer 15

Increase suze of air spaces distal to terminal bronchioles due to destruction of alveolar walls delaying exchnage of gases

Question 16

What sorts of things can damagw alveolar walls

Answer 16

Chromic infectioms which atttact neutrophils elastases and collagenases

Question 17

Damage to epithelium in emphysema can eventually cause what

Answer 17

Fibrosis scarring and further obstruction of gas exchange

Question 18

What are the air filled sacs called in emphysema seen on lungs

Answer 18

Bullae

Question 19

Which law relates to cb and reduced radius of airway to lower wirflwo

Answer 19

Poiseuilles law

Question 20

Which article discusses smoking and airway obstruction further

Answer 20

Sharafkhaneh et al 2008

Question 21

Which types of cells does smoke attract initially (sharafkhaneh)

Answer 21

Macrophages (also stimulates epi cels)

Question 22

What can amcrophages then attract eg cia il8 which allows emphysema

Answer 22

Neutrophils and cd8

Question 23

Which mmp is a neutrophil collagenase

Answer 23

Mmp 8

Question 24

What other things can neutrohpiks rleease for emphysema

Answer 24

Proteinase 3
Cathepsins
Gelatinases
Elastases

Question 25

Smoke inducing airway epithelium can cause release of what sorts of things

Answer 25

Egf,pdgf

Question 26

What does this allow

Answer 26

Epithelial remodelling (emt), mucous metaplasia

Question 27

Which artficle disccuses egf and emt into fibroblasts for fibrosis

Answer 27

Jolly er al 2017

Question 28

How does smoking have link to cancer throogh egf

Answer 28

Forms fibroblasts and emt process involved in cancer

Question 29

Why does emphysema cause v/q mismatch

Answer 29

Air sac damage and rupturing reduces sa of the lungs so ventilation is lower than perfusioj

Question 30

Which type of reap failure is this linked to

Answer 30

Type 1 where there is low po2 in arterial blood

Question 31

How does type 2 didfer

Answer 31

Low po2 but also high co2

Question 32

Give some examples of type 2 causes

Answer 32

Airway obstruction eg copd, opiates, resp muscle weakness

Question 33

What type of receptors are tolerated for high pco2 in type 2

Answer 33

Central chemorecpeotrs. So rely on perioheral for hypoxic activation

Question 34

Which article discusses oxygen induced hypercapnia

Answer 34

Jacono 2013

Question 35

How would giving oxygen lead to hypercapnis via perioheral

Answer 35

Giving high o2 switches peripheral off. This causes ventilatory depression and co2 is therefore not removed = hypercapnia

Question 36

Giving oxygen causes the haldene effect. What is this (jacono 2013)

Answer 36

Where xoygen binding to hb causes dissociation of co2 with hb = hypercapnia in arterial blood

Question 37

Jow is v/q mismatch usually pvercome in copd or poor ventilation

Answer 37

Hypoxic vasoconstriction

Question 38

How does giving oxygen affect this (jacono)

Answer 38

It causes increased blood flow to the poorly ventilated alveoli = further mismatching