COPD Flashcards
What is a major respiratory disease in Canada that is often preventable and can be treated, but remains underdiagnosed?
COPD
It is the thought that the prevalence of COPD is underestimated because those with earlier symptoms of COPD are not recognized and/or do not seek treatment.
True or False?
True
COPD affects at least 700,000 adults, approximately 4.4% of Canadians aged 35 years or older.
In this age group, is there a higher prevalence in males or females?
Females
Which group in Canada does COPD affects a much higher percentage of?
off reserve Aboriginal people (at 7.9%)
COPD is the 5th leading cause of death in females and 4th in males.
True or False?
False (COPD is the 4th leading cause of death in females and 5th in males.)
There is a higher prevalence for COPD, in women, except for the aged 75 years and older group.
True or False?
true
There is a higher prevalence for COPD, in women, except for the aged 75 years and older group.
True or False?
true
Mortality rates from COPD are higher in males (4.5/100,000) than females (2.8/100,000) and may actually be higher than reported because two complications of COPD, pneumonia and congestive heart failure, may be listed as the cause of death, instead of COPD.
True or False?
True
COPD is ranked what in the leading cause of death in the US and is the what rank of death in the worldwide?
US has COPD ranked 4th leading cause of death
6th cause of death worldwide
What is the condition of being ill, diseased, or unhealthy called?
Morbidity
What is the condition of being dead called?
Mortality
Morbidities always eventually lead to mortality.
True or False?
False
Morbidities may or may not lead to mortality.
The burden of COPD from a health, economical, and societal cost is not enough too cause an impact.
True or False?
False
Burden of COPD from a health, economical, and societal cost is significant.
Among major chronic illnesses in Canada, what now accounts for the highest rate of hospital admissions?
COPD (AECOPD)
How long, on average, is a hospitalization for AECOPD and how much does it cost?
10 days and $10,000
What is the leading cause of COPD and is the most important etiologic factor?
Cigarette smoking
15-25% of smokers will be diagnosed with COPD?
True or False?
true
An average smoker loses lung function at twice the rate of a nonsmoker; this means that smoking adults lose lung function at a more rapid rate as they age, in comparison to nonsmokers.
True or False?
True
Smoking is common in people with COPD, as 40-50% of them have a history of smoking.
True or False?
False (80-90%)
Smoking is toxic to cells in the lungs and also impairs the mechanisms responsible for _________ ____________ __________.
lung tissue repair
Other than smoking, what also play a contributing factor to developing COPD?
Genetics
Genetics susceptibilities have been identified for developing COPD.
Polymorphisms of genes that code for TNF, surfactant, proteases, and antiproteases are examples.
True or False?
True
A hereditary deficiency (mutation) in which gene may result in early onset and severe COPD?
Alpha-1 Antitrypsin (AAT Deficiency)
Alpha-1 antitrypsin gene may result in early onset and severe COPD (AAT deficiency)
The onset and severity is worsened by what?
Smoking
The heterogeneous nature of COPD can be attributed to multiple genetic and environmental factors as well as gene-gene & gene-environmental interactions, known as what?
epigenetics
Genetics have a role in how these phenotypes are expressed and how gene-environment interactions contribute to disease manifestations such as what?
exacerbations
What are environmental risk factors that could lead to COPD from inhalational exposure?
occupational dusts or chemicals, indoor pollution (from heating and cooking with biomass fuels), and outdoor pollution
What are some other risk factors, other than environmental risk factors, that could lead to COPD?
Severe childhood respiratory infections, asthma, airway hyper responsiveness, nutritional compromise, impairment of fetal development resulting in low birth weight, infants who develop bronchopulmonary dysplasia
COPD can be considered a SINGLE disorder.
True or False?
False
It is a group of disorders that are characterized by airflow
The different phenotypes of COPD may overlap and include what three?
chronic bronchitis, emphysema, and bronchiectasis
Which COPD phenotype is characterized by airway inflammation & obstruction of the major and small airways?
chronic bronchitis
Which COPD phenotype includes history of a chronic, productive cough for at least 3 consecutive months, over 2 consecutive years, and is required for clinical diagnosis?
chronic bronchitis
Which COPD phenotype is characterized by a loss of lung elasticity & abnormal enlargement of the airspaces distal to the terminal bronchioles, with destruction of the alveolar walls & capillary beds?
Emphysema
Which COPD phenotype is an uncommon form of COPD characterized by a permanent dilation of the bronchi and bronchioles?
- It is caused by destruction of the muscle and elastic supporting tissue due to vicious cycles of infection & inflammation.
Bronchiectasis
Although, asthma is a chronic inflammatory airway disorder, why is it not the same?
lung function is often normalized in the absence of triggers (especially early on in the disease, prior to significant airway remodeling)
Asthma is usually not classified as COPD, but together, asthma and COPD can be called obstructive airway diseases
True or False?
True
Comparing Asthma and COPD
When is the age of onset for asthma?
Anytime in childhood
Comparing Asthma and COPD
When is the age of onset for COPD?
midlife
Comparing Asthma and COPD
What is the smoking history for one with asthma?
Usually nonsmokers
Comparing Asthma and COPD
What is the smoking history for one with COPD?
Usually smokers
Comparing Asthma and COPD
What is the usual etiology (cause of the disease) for one with asthma?
Immunologic stimuli and family history
Comparing Asthma and COPD
What is the usual etiology (cause of the disease) for one with COPD?
Tobacco smoke or other air pollution
Comparing Asthma and COPD
Is the airflow limitation reversible or not fully reversible for one with asthma?
usually reversible
Comparing Asthma and COPD
Is the airflow limitation reversible or not fully reversible for one with COPD?
Not fully reversible
Comparing Asthma and COPD
What does the past medical history look life for one with asthma?
Allergies, sinusitis, respiratory infections and nasal polyps
Comparing Asthma and COPD
What does the past medical history look life for one with COPD?
Respiratory Infections (Allergies and sinusitis rare)
Comparing Asthma and COPD
What do clinical features look like for those with asthma?
Episodic wheeze with chest tightness, cough and dyspnea
Comparing Asthma and COPD
What do clinical features look like for those with COPD?
Persistent (or worsening) dyspnea and chronic cough
Comparing Asthma and COPD
What do inflammation features do those with asthma have?
Acute eosinophilic inflammation
Comparing Asthma and COPD
What do inflammation features do those with COPD have?
Neutrophil and macrophage induced inflammation
Comparing Asthma and COPD
The following are pathologic changes for COPD.
Fragile epithelium, thickening of basement membrane, mucus gland metaplasia and enlargement
True or False?
False
The following are pathologic changes for asthma
Comparing Asthma and COPD
The following are pathologic changes for asthma.
squamous metaplasia of epithelium, parenchymal destruction, mucus gland metaplasia and enlargement
True or False?
False
The following are pathologic changes for COPD
What is a respiratory disorder largely caused by smoking, characterized by progressive, partially reversible airway obstruction and lung hyperinflation, systemic manifestations, and increasing frequency and severity of exacerbations?
COPD
What is COPD is characterized by?
persistent inflammation of airways, lung parenchyma and its vasculature
What is the pathophysiological hallmark of COPD?
Expiratory flow limitation
What are the four most important mechanisms for airflow limitation (these can occur for asthma or COPD)?
Loss of lung elastic recoil, peribronchiolar fibrosis, increased airway secretions, airway smooth muscle
Which of the four most important mechanisms for airflow limitation occurs with emphysema due to protease mediated degradation of connective tissue elements in the lungs?
Loss of elastic recoil
Which of the four most important mechanisms for airflow limitation occurs due to an imbalance between the lung’s repair and defense mechanisms?
Peribronchiolar fibrosis
____________ of small airways contribute to airway remodeling, which is a key factor in the development of the irreversible airflow limitation seen in COPD.
Fibrosis
What is the persistent changes that occur within the structural components of the airways in response to inflammation?
Airway remodeling
Which of the four most important mechanisms for airflow limitation occurs in COPD and there is mucus hyperplasia and increased expression of mucin genes?
Increased airway secretions
What two things play a role in mucus hypersecretion?
Inflammation and oxidant injury
Which of the four most important mechanisms for airflow limitation includes an increased tone in airway smooth muscle due to hyperreactivity of the bronchi with bronchoconstriction, due to persistent inflammation?
Airway smooth muscle
Even if tone is not increased in airway smooth muscle in persons with COPD, their airways are narrower, resulting in an increase in what?
airway resistance
Airway smooth muscle - increased tone in airway smooth muscle due to hyperreactivity of the bronchi with bronchoconstriction, due to persistent inflammation.
Even if tone is not increased in persons with COPD, their airways are narrower, resulting in an increase in airway resistance
Relaxing airway smooth muscle with bronchodilators will have a detrimental effect on airflow no matter what.
True or False?
False
(Relaxing airway smooth muscle with bronchodilators will have a beneficial effect on airflow whether there is increased tone or not.)
People diagnosed with COPD usually have some degree of which two phenotypes of COPD?
emphysema and chronic bronchitis
What COPD phenotype is the result of inflammation of the airway epithelium and mucus hypersecretion, due to inspired irritants like tobacco smoke or air pollution?
chronic bronchitis
What is the first feature of chronic bronchitis?
Mucus Hypersecretion in the large airways
Mucus Hypersecretion in the large airways is the first feature of chronic bronchitis
There is an increase in the size and the number of ___________ __________ and ___________ ___________ in airway epithelium
Mucous glands and goblet cells
Mucus Hypersecretion in the large airways is the first feature of chronic bronchitis
There is an increase in the size and the number of mucous glands & goblet cells in airway epithelium.
The mucus produced is _________ and more ____________ (tending to keep a firm hold of something; clinging or adhering closely.)
thicker and tenacious
Within chronic bronchitis, what causes the reduction in mucus clearing?
impaired ciliary function
When the lung’s defense mechanisms are compromised (like in chronic bronchitis), there is an increased risk of what?
pulmonary infection and injury (there may be bacterial colonization occurring)
Bacteria such as Haemophilus influenza and streptococcus pneumoniae can become embedded in the what?
airway secretions
Infection and injury cause further mucus production and inflammation
True or False?
true
Recurrent infections and persistent inflammation result in what two things?
bronchospasm and eventual permanent narrowing of the airways
Organize the steps in chronic Bronchitis.
A ) Eventually, if not reversed, hypoxemia will lead to pulmonary hypertension and Cor pulmonale (which is enlargement of the right ventricle)
B ) Airway obstruction causes ventilation-perfusion mismatch, hypercapnia and hypoxemia
C ) Pulmonary hypertension and Cor pulmonale can then cause right heart failure
D ) Significant Hypoxemia will lead to polycythemia (which is the over production of RBCs) and cyanosis.
E ) Thick mucus & hypertrophied bronchial smooth muscle leads to airway obstruction.
- Air trapping can result as the airways collapse early in expiration, when the airways are narrows, trapping gas in the distal portion of the lungs.
E, B, D, A, C
What COPD phenotype is characterized by the breakdown of elastin in the alveolar septa and bronchial walls (as well as breakdown of alveolar and bronchial wall components) by proteases?
(What are proteases?)
Emphsyema
Proteases are enzymes that digest proteins
Emphysema occurs due to imbalance between proteases and antiproteases as a result of increased protease activity and inhibition of what?
normal endogenous antiprotease activity (in the lungs)
The leading cause of the imbalance between proteases and antiproteases as a result of increased protease activity and inhibition of normal endogenous antiprotease activity in the lungs, is airway epithelial inflammation, from toxins in what two things?
Tobacco smoke or air pollution
Where are proteases released from?
inflammatory cells
What are three examples of the most important proteases activated in emphysema?
elastases, cathepsins and matrix metalloprotease
Normally antiproteases (such as alpha1-antitrypsin) inhibit _____________ in the lungs; however, antiprotease production and release is inadequate in smokers with COPD.
proteases
What type of emphysema is commonly linked to an inherited deficiency of alpha1-antitrypsin and accounts for approximately 1-3% cases.
Primary emphysema
Primary emphysema is commonly linked to an inherited deficiency of ________-_______________ and accounts for approximately 1-3% cases.
alpha1-antitrypsin
Primary emphysema often develops in individuals who develop the disease before age 40 or in their early 40s and do not have a smoking history.
True or False?
true
Primary emphysema often develops in individuals who develop the disease before age 40 or in their early 40s and do not have a smoking history.
True or False?
true
Persons with inherited alpha1-antitrypsin deficiency with a history of smoking are even more susceptible to developing emphysema.
True or False?
True
Septal destruction destroys portions of the pulmonary capillary bed causing what?
ventilation-perfusion mismatch (and eventually hypoxemia)
Within emphysema, decreased elastic recoil in ______________ ___________ contributes to air trapping
bronchial walls
Within emphysema, there is an abnormal enlargement of gas exchange airways (called acin) due to what?
air trapping
Within emphysema, due to the air trapping, what two things are inevitable?
An increase in Residual Volume (RV) and Total Lung Capacity (TLC)
Within emphysema, persistent inflammation of the airways can result in what?
hyperreactivity of the bronchi with bronchoconstriction
Within emphysema, when smoking or air pollution initiates an inflammatory response, which inflammatory cells release elastin?
neutrophils and alveolar macrophages
Within Emphysema:
Smoking or air pollution initiates an inflammatory response.
Inflammatory cells, specifically neutrophils and alveolar macrophages release elastin.
The action of elastin is normally inhibited by what?
alpha1-antitrypsin
Within Emphysema:
Smoking or air pollution initiates an inflammatory response.
Inflammatory cells, specifically neutrophils and alveolar macrophages release elastin.
The action of elastin is normally inhibited by alpha1-antitrypsin; however, as inflammation persists, there is a _______________ in alpha1-antitrypsin activity.
decrease
Within Emphysema:
Smoking or air pollution initiates an inflammatory response.
Inflammatory cells, specifically neutrophils and alveolar macrophages release elastin.
The action of elastin is normally inhibited by alpha1-antitrypsin; however, as inflammation persists, there is a decrease in alpha1-antitrypsin activity.
In turn, there is destruction of which part of the lung?
elastic fibres in the lung (resulting in emphysema)
Within Emphysema:
In the case of inherited alpha1-antitrypsin deficiency, there is a limited amount of alpha1-antitrypsin to counteract elastase released.
True or False?
True
Within Emphysema:
The amount of alpha1-antitrypsin is determined by a pair of codominant genes named what?
protein inhibitor genes
There are more than 75 mutations of the gene, which are inherited as an autosomal recessive disorder.
Within Emphysema:
The most serious alpha1-antitrypsin deficiency is caused by the ______-____________, which is found in 5% of the population.
PIZ variant
Within Emphysema:
Homozygous individuals who carry 2 PIZ genes, only have 15-20% of the normal plasma concentration of alpha1-antitrypsi and have a 70-80% likelihood of developing emphysema.
True or False?
true
