Chronic Obstructive Pulmonary Disease (COPD)

Question 1

chronic obstructive pulmonary disease

Answer 1

• persistent, widespread inflm of the airway, parenchyma and vasculature
• acute, recurrent & chronic obstr of a/w

Question 2

parenchyma

Answer 2

epith cells involved in gas exchange at alveolar level

Question 3

vasculature

Answer 3

vessels involved in gas exchange (ex. pulmonary capillaries)

Question 4

COPD is a combination of:

Answer 4

• chronic bronchitis

- emphysema (may co-exist with asthma)

Question 5

et & risks

Answer 5

• smoking (80-90%)
• recurrent resp infects
• aging
• genetic deficiency of a1 antitrypsin

Question 6

how does smoking cause COPD

Answer 6

• cigarette smoke has irritants that irritate the respiratory tract causing goblet cells to inc mucus production (defense mechanism to protect a/w lining) –> impedes gas exchange
• irritants in smoke damage cilia
• irritants induce coughing which if persistent can inflame a/w lining & alveoli causing further damage

Question 7

how do recurrent resp infections cause COPD

Answer 7

causes chronic hypersecretion of mucus, coughing and inflammatory damage

Question 8

how does aging cause COPD

Answer 8

causes degeneration of tissue which dec elasticity + inc compliance of lungs

Question 9

dx

Answer 9

• Hx, Px
• CXR
• pulmonary Fx tests (spirometry)
• labs (CBC, CRP)

Question 10

what does Hx & Px assess

Answer 10

• breath sounds
• ventilation issues
• SOB
• accessory muscle use
• arms propped on table to facilitate breathing

Question 11

CXR purpose

Answer 11

to find consolidation, damage and dec lung vol

Question 12

spirometry components

Answer 12

• forced vital capacity (FVC)
• forced expiratory vol (FEV1)
• total lung volume & tidal volume

Question 13

FVC

Answer 13

maximum total volume forcefully exhaled

Question 14

FEV1

Answer 14

vol of air forcefully exhaled in 1 second

Question 15

total lung volume + tidal volume

Answer 15

normal volume when no extra effort is being used

Question 16

Tx

Answer 16

• cessation of smoking
• avoid airway irritants
• vaccines (flu shot)
• drugs (stage-based)

Question 17

drugs used in early stage (1)

Answer 17

• short-acting beta agonists (aka “B-adrenergic agonists”)

- anticholinergics

Question 18

drugs used in more advanced COPD (2)

Answer 18

• inhaled steroids

Question 19

drugs used in late stages (3)

Answer 19

• long-acting B agonists (prescribed w/ glucocorticosteroids)
• Xanthine Derivatives (theophylline)

Question 20

short-acting beta agonists (aka “B-adrenergic agonists”) (1)

Answer 20

bronchodilators that stimulate B2 adrenergic receptors in the lungs, activating adenylate cyclase to produce cyclic adenosine monophosphate (cAMP) –> triggers relaxation of bronchial smooth muscle

Question 21

anticholinergics (1)

Answer 21

bronchodilators that block ACh receptors on the bronchial tree so that the PNS is not activated to release more ACh, resulting in bronchodilation

Question 22

inhaled steroids action (2)

Answer 22

dec inflm by dec release of mediators and limiting WBC activity, and inc responsiveness of bronchial smooth muscle to B-agonists

Question 23

xanthine derivatives (theophylline) action (3)

Answer 23

• causes bronchodilation by inc levels of cAMP to trigger smooth muscle relaxation
• has anti-inflm action by inhibiting IgE release