COPD Flashcards
COPD is progressively worsening, _______ airflow limitation
irreversible
What are 3 types of COPD?
Chronic bronchitis
Emphysema
A1AT deficiency (alpha 1 antitrypsin)
What are risk factors for COPD?
Cigarettes
Pollution
Genetics
What type of inheritance is shown in A1AT deficiency?
Autosomal recessive
In chronic bronchitis, there is h____ and h____ of mucous glands to protect against damage, commonly caused by cigarette use
Hypertrophy and hyperplasia
In chronic bronchitis, chronic inflammation cells infiltrate the bronchi and bronchioles causing…
Luminal narrowing
What 3 factors in chronic bronchitis all increase the risk of an infection and airway trapping?
Mucous hypersecretion
Ciliary dysfunction
Narrowed lumen
What term was used to describe the stereotypical features of a chronic bronchitis patient
Blue bloater
Severe difficulty breathing causing decreased oxygen –> cyanosis, blueish tint.
Sometimes also overweight/obese.
Term not used today
Chronic bronchitis is a productive cough (produces mucous) of more than _ months, occurring within a span of _ years
3 months
2 years
How do patients with chronic bronchitis typically present?
Chronic productive cough (produce mucous)
Malaise
Chest pain
Abdominal pain
What is emphysema?
Destruction of the elastin layer in alveoli ducts and sacs and respiratory bronchioles (final part after terminal bronchiole)
Irritants like smoke from cigarettes triggers inflammatory reaction in alveolar walls and subsequently affects gas exchange. Name some inflammatory chemicals the immune cells release at the alveoli.
Leukotriene B4
IL-8
TNF-a
(Also elastases and collagenases present)
What is the role of elastin in the alveolar sacs, ducts and respiratory bronchioles?
Keeps the walls open during expiration (Bernouli principle)
What happens when there is less elastin (eg in emphysema) in the alveoli?
Walls close on expiration and air is trapped distal to blockage, causing large air sacs called bullae
What type of emphysema only affects respiratory bronchioles and proximal alveoli/ upper lobes of lungs?
Centriacinar emphysema (more common type)
Thought that smoke doesn’t make it all the way to distal alveoli
What is panacinar emphysema?
Air trapping across entire acinus (respiratory bronchioles, alveoli ducts and sacs)
What condition is associated with panacinar emphysema?
Alpha-1 antitrypsin deficiency
What do macrophages in the alveoli do in a healthy individual
Release proteases which helps to clear any debris
What is the role of alpha-1 antitrypsin inhibitors?
Protease inhibitor so protects against unintended damage from the proteases released by the macrophages
Where in the lungs does panacinar emphysema typically affect?
The lower lobes
Where does paraseptal emphysema affect?
The distal alveoli near the periphery of the lobules near the interlobular septa
What is a complication of paraseptal emphysema?
The ballooned out alveoli on lung surface may rupture and cause a pneumothorax
Where is alpha 1 antitrypsin produced?
The liver
When should A1AT deficiency be suspected?
In younger/middle age men with COPD symptoms but no smoking history
What term was used to describe the stereotypical features of an emphysema patient?
Pink puffer
Minimal cough
Pursed lip breathing
Muscle wasting (cachectic)
Barrel chest
Hyper-resonant percussion
True or false: COPD patients often have either chronic bronchitis or emphysema?
False
Often have a mix of both simultaneously
What does 0 mean on the dyspnoea grading scale?
No trouble with breathing except with strenuous exercise
What does 5 mean on the dyspnoea grading scale mean?
Too breathless to leave house / breathless with dressing
How do you diagnose COPD?
Pulmonary function test:
Increased fractional expired NO indicates lung damage
FEV1:FVC is less than 0.7 indicates obstruction on PFT spirometry
There is a less than 12% improvement in FEV1 with a bronchodilator in COPD (more than 12% in asthma)
Genetic testing for A1AT deficiency
ABG (type 2 resp failure)
ECG
Chest XR may show flattened diaphragm and bullae formation
What happens to the diffusing capacity of CO across the lung in COPD?
It decreases
(is normal in asthma)
What is the initial stage in treating COPD?
Smoking cessation
Influenza and pneumococcal vaccines
What is the first medication for long term management of COPD?
SAB2A as required (salbutamol)
What is added if just SABA is not enough for COPD?
LAB2A (eg salmeterol) and LAM3A (tiotropium)
What is added to SABA, LAB2A and LAM3A for treating COPD?
ICS (inhaled corticosteroid)
What is a complication of COPD?
Cor pulmonale (RHS heart failure due to increased portal hypertension)
Long term oxygen is considered for severe COPD when oxygen is less than __% or less than __% with heart failure
88%
90% with heart failure
Which 2 pathogens cause infections and exacerbate the COPD?
Streptococcus pneumoniae
Haemophilus Influenzae
