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KIN 435 > Chronic Obstructive Lung Disease > Flashcards

Chronic Obstructive Lung Disease Flashcards

1
Q

What is the Definition of Chronic Obstructive Pulmonary Disease (COPD)?

A
  • a common, preventable, and treatable disease
  • characterized by persistent respiratory symptoms and airflow limitation
  • Due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles
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2
Q

What is COPD characterized by?

A
  • persistent respiratory symptoms and airflow limitations
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3
Q

What are the Characteristics of COPD due to?

A
  • airway and/or alveolar abnormalities
  • usually caused by significant exposure to noxious particles or gases
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4
Q

What are some COPD stats?

A
  • 4th leading cause of death
  • 3rd leading cause of death by 2020
  • 3million died of COPD in 2012 (6% of all deaths)
  • COPD burden expected to increase
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5
Q

What is the Etiology of COPD?

A
  • Smoking
  • Pollutants
  • Host Factors
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6
Q

What is the Pathobiology of COPD?

A
  • Impaired lung growth
  • accelerated decline
  • lung injury
  • lung & systemic inflammation
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7
Q

What is the Pathology of COPD?

A
  • Small airway disorders or abnormalities
  • Emphysema
  • Systemic Effects
  • Chronic Inflammation
  • Structural Changes
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8
Q

What are the Clinical Manifestations of COPD?

A
  • Symptoms
  • Exacerbations
  • Comorbidities
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9
Q

What are the most common respiratory symptoms of COPD?

A
  • Dyspnea
  • Cough
  • Sputum production
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10
Q

What are the main risk factors of COPD?

A
  • Tobacco Smoking (MAIN)
  • environmental exposures (biomass fuel and air pollution)
  • genetic abnormalities
  • abnormal lung development
  • accelerated aging
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11
Q

What is COPD commonly punctuated by?

A
  • periods of acute worsening of respiratory symptoms
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12
Q

What are exacerbations?

A
  • periods of acute worsening of respiratory symptoms
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13
Q

What increases morbidity and mortality in most patients with COPD?

A
  • Significant concomitant chronic diseases
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14
Q

What is the Pathogenesis of COPD?

A
  • Oxidative Stress
  • Protease-antiprotease imbalance
  • Inflammatory cells
  • Inflammatory mediators
  • Peribronchiolar and Interstitial Fibrosis
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15
Q

What is the Pathophysiology of COPD?

A
  • Airflow limitation and gas trapping
  • Gas exchange abnormalities
  • Mucus Hypersecretion
  • Pulmonary Hypertension
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16
Q

What Symptoms are looked for in the Diagnosis of COPD?

A
  • Shortness of Breath
  • Chronic Cough
  • Sputum
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17
Q

What is required for a diagnosis of COPD?

A
  • Spirometry
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18
Q

What are the Key indicators of diagnosing COPD?

A
  • Dyspnea
  • Chronic Cough
  • Chronic Sputum Production
  • Recurrent lower respiratory tract infection
  • History of Risk Factors
  • Family History of COPD
  • Childhood Factors
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19
Q

Describe what to look for in Dyspnea when attempting to diagnose COPD

A
  • Progressive over time
  • Characteristically worse with exercise
  • Persistent
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20
Q

Describe what to look for in Chronic Cough when attempting to diagnose COPD

A
  • May be intermittent and my be unproductive
  • Recurrent Wheeze
21
Q

When would chronic sputum production possibly indicate COPD?

A
  • any pattern of chronic sputum production may indicate COPD
22
Q

What history of Risk Factors would you look for when attempting to diagnose COPD?

A
  • Host Factors (genetic, congentital/development abnormalities)
  • Tobacco Smoke
  • Smoke from home cooking and heating fuels
  • Occupational dusts, vapors, fumes, gases, and chems
23
Q

What childhood factors might be used to diagnose COPD?

A
  • low birthweight
  • childhood respiratory infections
24
Q

What are normal Spirometry results?

A
  • FEV1 = 4L
  • FVC = 5L
  • FEV1/FVC = 0.8
25
Q

What are spirometry results seen in someone with COPD?

A
  • FEV1 = 1.8L
  • FVC = 3.2L
  • FEV1/FVC = 0.56
26
Q

What are the Airflow Limitation Severities in COPD?

A
  • Gold 1
  • Gold 2
  • Gold 3
  • Gold 4
27
Q

Describe Gold 1 Severity in COPD

A
  • Mild
  • FEV1 > 80% predicted
28
Q

Describe Gold 2 Severity in COPD

A
  • Moderate
  • 50% < FEV1 < 80% predicted
29
Q

Describe Gold 3 Severity in COPD

A
  • Severe
  • 30% < FEV1 < 50% predicted
30
Q

Describe Gold 4 severity in COPD

A
  • Very Severe
  • FEV1 < 30% predicted
31
Q

What is Emphysema?

A
  • Loss of elastic lung recoil with attendant airway collapse during expiration
  • Impaired pulmonary gas exchange (decrease surface area)
32
Q

What is Bronchitis?

A
  • Chronic airway obstruction due to inflammatory narrowing and airway hypersecretion (mucus)
33
Q

What are some exercise-limiting symptoms of COPD?

A
  • intolerable exertional symptoms
  • Dyspnea (breathlessness) primary reason
34
Q

What is Dynamic Hyperinflation?

A
  • Mechanically constrains further tidal volume expansion, despite progressive
  • Increase in central ventilatory drive (VCO2)
  • No room to breathe
35
Q

What are the Physiological Consequences of Dynamic Hyperinflation?

A
  • mechanical restraint of Tidal Volume during progressive exercise
  • Increase in effort for given ventilation during exercise
  • Relationship between respiratory effort and thoracic displacement increases progressively during exercise
  • Increased perception of exertional dyspnea and exercise intolerance
36
Q

What are the Pathophysiological mechanisms of Exertional Dyspnea in COPD?

A

Increased
- limbic system activation
- motor drive
- central neural drive
Decreased
- Mechanical Response
Altered
- Afferent Activity

37
Q

What do Bronchodilators do?

A

Improve
- lung function
- exertional dyspnea
- exercise tolerance
Decrease
- cholinergic airway smooth muscle tone
- lung volume
- work and O2 cost of breathing
- EFL
- DH
- Intensity of exertional dyspnea

38
Q

What does Cholinergic Airway Smooth Muscle Tone do in COPD?

A
  • Bronchoconstriction: airway narrowing
  • Decreases amount of air exhaled
39
Q

How do Bronchodilators improve Dyspnea?

A

Decrease
- Expiratory Flow Limitations
- Dynamic hyperinflation
- Prevent neuromechanical uncoupling of respiratory system

40
Q

Why would you use Bronchodilators as a treatment for COPD?

A
  • Permit greater tidal volume expansion during submaximal exercise
  • Preserve relationship effort (efferent) during exercise
  • preserve mechanical response of the respiratory system during exercise
  • Alleviates exertional dyspnea
41
Q

What do exercise intolerance and increased O2-cost of physical activity in COPD lead to?

A
  • diminished quality of life
  • Increased mortality
42
Q

What is evidence that peripheral mechanisms to the pulmonary system are involved in the dysfunction of skeletal muscles during COPD?

A
  • Physical Function persist after lung function is restored by transplantation or other therapeutic means
43
Q

What are possible etiologies of muscle dysfunction in COPD? (12)

A
  • Genetics
  • Cigarette Smoke
  • Systemic Inflammation
  • Nutritional Abnormalities
  • Metabolism
  • Hypoxia
  • Hypercapnia-Acidosis
  • Decrease Physical Activity
  • Exacerbations
  • Aging
  • Comorbidities
  • Drugs
44
Q

What Biological Events contribute to skeletal muscle dysfunction in COPD? (14 - 1, 7, 6)

A

Increased (1)
- Proteolysis
Decreased (7)
- Protein Synthesis
- % Type 1 Fibers
- Capillary Contact
- Mitochondrial Density
- Enzyme Capacity
- Myoglobin
- regeneration
Others (6)
- Oxidative Stress
- Muscle Damage
- Apoptosis
- Autophagy
- Atrophy
- Endoplasmic reticulum stress

45
Q

What was the article on the influences of spinal anesthesia on exercise tolerance in patients with COPD Objective?

A

Compare (during constant work-rate cycling exercise)
- endurance time
- cardiopulmonary response
- quadriceps muscle fatigue

46
Q

What two groups were the COPD patients split into for the article on exercise tolerance?

A
  • sham
  • active spinal anesthesia
47
Q

What was the reason for active spinal anesthesia?

A
  • Inhibiting central feedback of group III/IV lower limb muscle sensory afferents
48
Q

What was the conclusion of the article on exercise intolerance in COPD patients?

A
  • Spinal Anesthesia enhanced cycling exercise tolerance in patients with COPD
  • Mostly reducing the ventilatory response and dyspnea during exercise
49
Q

Why might there have been enhanced exercise tolerance in patients with COPD who had active spinal anesthesia?

A
  • Inhibition of group III/IV lower limb sensory muscle afferents

KIN 435 (14 decks)

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