COPD Flashcards
Characteristics of COPD
Airflow limitation
- Not fully reversible
- Chronic & progressive
Preventable
Treatable
COPD Pathophysiology
Reversible: small airways dz, airway inflammation & increased airway resistance
Irreversible: parenchymal destruction, loss of alveolar attachment, decrease in elastic recoil, airway fibrosis
Risk Factors for COPD
- Cigarette smoking 85-90%!
- Exposures: env. Tobacco smoke, occupational dusts, chemicals and air pollution
- Host factors: genetics predisposition (AAT deficiency), airway hyper-responsive, impaired lung growth
COPD vs Asthma: cells
COPD: neutrophils, large increase in macrophages
Asthma: eosiniophils, small increase in macrophages, activation of mast cells
COPD vs Asthma: mediators
COPD: LTB4, IL8, TNF-a
Asthma: LTD4, IL4, IL5
COPD vs Asthma: Consequences
COPD: parenchymal destruction, mucus metaplasia, glandular enlargement
Asthma: thickening of basement membrane; mucus metaplasia, glandular enlargement
COPD vs Asthma: response to Tx
COPD: Glucocorticoids have variable effect
Asthma: Glucocorticoids inhibit inflammation
COPD: symptoms
Chronic cough
Sputum production
Dyspnea
COPD: PE
- Cyanosis of mucosal membranes
- Barrel chest
- ↑resting respiratory rate
- Shallow breathing
- Pursed lips during expiration
- Use of accessory respiratory muscles
COPD: Diagnostic Tests
- Spirometry with reversibility testing
- Radiograph of chest
- Arterial blood gas (not routine)
COPD Prevention
- Smoking cessation
- Vaccination
- Influenza
- ↓ illness causing hospitalizations in COPD
- ↓ mortality in COPD
- Influenza
- Pneumococcal
- ↓ incidence of community acquired pneumonia in COPD
COPD: medication classes
- SABA
- SAA – short acting antichol
- LABA
- LA-anticholinergics
- ICS
- Phosphodiesterase Inhibitors
COPD: SABAs
- Albuterol
- Levalbuterol
- Pirbuterol
COPD: SAAs
Ipratropium
COPD: LABAs
- Salmeterol
- Formeterol
- Arformeterol
- Indacaterol