COPD Flashcards
What is the global rank of COPD as a cause of death?
3rd cause of death worldwide
What are the persistent symptoms of COPD?
Respiratory symptoms and airflow limitation that is not fully reversible
What test is used to determine chronic airflow obstruction in COPD?
Spirometry
What is the most common environmental factor leading to COPD?
Cigarette smoking
What characterizes emphysema in COPD?
Destruction of lung alveoli with air space enlargement distal to terminal bronchioles
How is chronic bronchitis clinically defined?
Chronic cough and sputum production for at least 3 months per year over 2 consecutive years
What are the most common risk factors for COPD?
Tobacco smoking, air pollutants, occupational dusts, chemicals, infections, and genetic α1-antitrypsin deficiency
What causes the chronic airflow limitation in COPD?
A mixture of small airways disease and parenchymal destruction
What inflammatory cells are triggered by chronic exposure to cigarette smoke?
Macrophages, neutrophils, T lymphocytes, and B lymphocytes
What imbalance contributes to extracellular matrix destruction in COPD?
Protease-antiprotease and oxidant-antioxidant imbalance
What are the main pathophysiologic findings in COPD?
Persistent reduction in FEV1, air trapping, and ventilation-perfusion mismatching
What defines centrilobular emphysema?
Enlarged air spaces in respiratory bronchioles, typically in the upper lobes
Which type of emphysema is associated with α1-antitrypsin deficiency?
Panlobular emphysema
What is the hallmark symptom of COPD?
Dyspnea
What physical finding indicates advanced COPD?
Barrel-shaped chest, hyperresonance on percussion, and use of accessory muscles
How is chronic bronchitis distinct from emphysema in terms of symptoms?
Chronic bronchitis involves a productive cough and cyanosis, while emphysema involves minimal cough and cachexia
What is the GOLD criterion for severe COPD?
FEV1 between 30% and 50% of predicted
What questionnaire is used to assess the severity of dyspnea in COPD?
Modified Medical Research Council (mMRC) Questionnaire
What is the primary basis for the Refined ABCD Assessment?
Respiratory symptoms and exacerbation history
What is the first step in managing COPD?
Smoking cessation
What combination therapy is preferred for managing mild exacerbations in COPD?
LAMA + LABA
What surgical option is available for patients with non-functional lung tissue in COPD?
Lung volume reduction surgery
What non-pharmacological therapy improves exercise tolerance in COPD?
Pulmonary rehabilitation
Why do not all smokers develop COPD?
Favorable DNA mutations and larger airway-to-lung size ratio
What are the key imaging findings in emphysema?
Flattened hemidiaphragms, hyperlucent airways, and bullae on CT scan
What type of emphysema spares central areas and is distributed along pleural margins?
Paraseptal emphysema
What is the role of α1AT augmentation therapy in COPD?
Used for patients with α1-antitrypsin deficiency
What environmental factors besides smoking contribute to COPD?
Air pollutants and occupational exposures
What genetic deficiency increases the risk of early-onset COPD?
α1-antitrypsin deficiency
What is the primary mechanism by which cigarette smoke damages the lungs?
Triggers inflammatory and immune cell recruitment
Which type of inflammation is central to COPD pathogenesis?
Chronic inflammation leading to structural changes
How does small airway disease manifest in COPD?
Narrowed and reduced small bronchioles
What cellular imbalance leads to emphysema?
Protease-antiprotease imbalance
What type of metaplasia is observed in large airways of COPD patients?
Squamous metaplasia
Which lung cells are increased but have reduced phagocytic capacity in COPD?
Macrophages
What causes the hyperinflation observed in COPD?
Air trapping due to expiratory outflow obstruction
What is the typical appearance of lungs in emphysema on gross examination?
Enlarged air spaces with destruction of alveolar walls
What histopathologic feature differentiates emphysema from chronic bronchitis?
Destruction of alveolar walls in emphysema
What differentiates pink puffers from blue bloaters in COPD?
Pink puffers have minimal cough and cachexia; blue bloaters have chronic cough and cyanosis
At what FEV1 level does PaCO2 elevation become expected in COPD?
FEV1 <25% of predicted
What is the clinical significance of the RV/TLC ratio in COPD?
Indicates air trapping and hyperinflation
Why is pulmonary rehabilitation important in COPD?
Improves exercise tolerance and well-being
What role does roflumilast play in COPD management?
PDE-4 inhibitor with anti-inflammatory properties
How does long-term oxygen therapy benefit COPD patients?
Prevents pulmonary hypertension and cor pulmonale in hypoxemic patients
What is the purpose of intrabronchial valves in COPD treatment?
Deflate hyperinflated lung segments to reduce lung volume
What imaging findings are pathognomonic for emphysema?
Bullae and hyperlucent airways
What does ventilation-perfusion mismatch lead to in COPD?
Gas exchange abnormalities
Which COPD patients are candidates for lung transplantation?
Advanced disease with severe functional impairment
What findings on physical exam suggest advanced COPD?
Cachexia, bitemporal wasting, and barrel chest
What cytokines are involved in COPD-related inflammation?
TNF-α and IL-8
What is the impact of elastin destruction in COPD?
Airspace enlargement and emphysema formation
Why are COPD patients prone to respiratory infections?
Impaired mucociliary clearance and inflammation
How does the CAT assessment differ from mMRC?
CAT quantifies COPD impact; mMRC focuses on dyspnea severity
What structural changes occur in small airways of COPD patients?
Goblet cell metaplasia, smooth muscle hypertrophy, and luminal narrowing
What is the clinical utility of the GOLD criteria?
Defines airflow obstruction severity based on spirometry
Which type of emphysema is focal and often seen in smokers?
Centrilobular emphysema
What systemic effect is associated with COPD cachexia?
Hypercatabolic state due to elevated inflammatory cytokines
Why is spirometry critical in COPD diagnosis?
Confirms airflow limitation and assesses severity
What is the significance of Hoover’s sign in COPD?
Paradoxical inward movement of the rib cage during inspiration
What interventions help reduce COPD exacerbations?
Smoking cessation, vaccines, and pharmacotherapy like LAMA/LABA
What is the role of PDE-4 inhibitors in COPD?
Reduce inflammation and exacerbations in severe COPD patients
How do proteases contribute to COPD?
Destroy extracellular matrix and alveolar walls
What imaging technique is best for detecting bullae in COPD?
CT scan
