COPD Flashcards
what are the 3 main types of COPD
- Chronic bronchitis
- Emphysema
- A1AT deficiency
define COPD
progressively worsening, irreversible airflow limitation
risk factors for COPD
- cigarettes
- air pollution
- genetics
- male
- older age
pathophysiology of chronic bronchitis
- hypertrophy and hyperplasia of mucous glands to protect vs cigarette smoke
- chronic inflammatory cells infiltrate bronchi = luminal narrowing
- leads to mucus hypersecretion, ciliary dysfunction, narrowed lumen
- therefore increased infection risk and airway trapping
pathophysiology of emphysema
- destruction of elastin layer of resp bronchioles/alv ducts/alv sacs (keeps them open) = leads to distal air trapping
- can form BULLAE
- two main types:
- centriacinar (resp bronchioles involved only - SMOKERS
- panacinar (A1AT deficiency!)
what is the role of elastin
keeps walls open during expiration
- therefore decreased elastin means air trapped distal to blockage
what are bullae
large air sacs
pathophysiology of A1AT deficiency
autosomal co-dominant inheritance
- A1 antitrypsin degrades NE which protects excess damage to elastin layer in lungs
- A1 antitrypsin deficiency means more NE
- leads to panacinar emphysema and liver issues
who to suspect A1AT deficiency in
suspect in male px <40 with little/ no smoking Hx
symptoms of COPD
- CHRONIC PRODUCTIVE COUGH with purulent sputum (NO DIURNAL VARIATION, constant, for 2+ years),
- dyspnoea
- often get chest infections.
signs of COPD
classic barrel chest
what does blue boater refer to
chronic bronchitis
more overweight, cyanotic
what does pink puffer refer to
ephysema
thinner px, barrel chest, muscle wasting, pursed lip breathing
how to diagnose COPD
Pulmonary function tests
how to carry out pulmonary function tests
- do Fraction expired nitrous oxide (feNO) = raised non specific in lung damage
- Then do Spirometry = FEV1:FVC less than 0.7 (obstruction)
- Then do bronchodilator reversibility test = less than 12% increase in FEV1 (IRREVERSIBLE)
