COPD Flashcards
Airflow limitation that is not fully reversible (Harrison pp 1700)
COPD
COPD includes the following characteristics: (Harrison pp 1700)
Emphysema
Chronic Bronchitis
Small airway disease
Major physiologic changes with COPD (Harrison pp 1700)
Airflow limitation
4 intercalated events in the pathogenesis of emphysema (Harrison pp 1700)
Cigarette smoking
Inflammation
Structural cell death
Ineffective repair of elastin
Balance of elastin degrading enzymes and their inhibitors determines the susceptibility of the lung to destruction (Harrison pp 1700)
Elastase: antielastase hypothesis
What are the macrophage elastase involved? (Harrison pp 1701)
Neutrophil elastase
Matrix metalloproteinases
Serine proteinases
Most potent secretagagues identified (Harrison pp 1701)
Neutrophil elastase
Destruction and enlargement of the lung alveoli (Harrison pp 1700)
Emphysema
Centroacinar emphysema (Harrison pp 1701)
Cigarette smoking
Upper lobes and Superior segments of lower lobes
Focal
Panancinar emphysema (Harrison pp 1701)
Acinar units
Alpha1 AT deficiency
What accumulate in respiratory bronchioles of essentially ALL YOUNG SMOKERS? (Harrison pp 1701)
Macrophage
Most typical pathophysiology findings of COPD (Harrison pp 1701)
↓ Forced Expiratory Flow Rates
Pathophysiology of COPD (Harrison pp 1701)
Î Residual volumes
Î Residual lung/total lung capacity ratio
Nonuniform distribution of ventilation
Ventilation-perfusion mismatching
How much FEV1 is decreased to manifest/affect the O2? (Harrison pp 1702)
FEV <50%
How much FEV1 is decreased to manifest/affect the pCo2? (Harrison pp 1702)
FEV <25%
It is most highly significant predictor FEV1 (Harrison pp 1702)
Cigarette smoking
Asthma, chronic bronchitis and emphysema are all same entities (Harrison pp 1702)
Dutch Hypothesis
It is consider as a risk factor for COPD (Harrison pp 1703)
Airway hyperresponsiveness
Common mode of cooking in some countries (Harrison pp 1703)
Biomass combustion
Most common form of severe alpha1 AT deficiency (Harrison pp 1703)
PiZ
3 most common symptoms in COPD (Harrison pp 1704)
Cough
Sputum production
Exertional dyspnea
In advance COPD, what is the principal feature? (Harrison pp 1704)
Worsening dyspnea on exertion with increasing intrusion on the ability to perform vocational or avocational activities
In tripod position, what muscles are involved? (Harrison pp 1704)
S ternocledomastoid
I ntercostal muscle
S calene
Pink puffers (Harrison pp 1704)
Emphysema
Thin and Acyanotic
Blue bloaters (Harrison pp 1704)
Heavy and Cyanotic
It is an independent POOR prognostic factor in COPD (Harrison pp 1704)
Wasting
Paradoxical inward movement of rib cage with inspiration (Harrison pp 1704)
Hoover’s Sign
It is an important prognostic factor in COPD (Harrison pp 1704)
Degree of airflow obstruction
FEV1/FVC <0.7 and FEV1 ≥ 50% but <80% (Harrison pp 1704)
Moderate (GOLD II)
FEV1/FVC <0.7 and FEV1 ≥30% but <50% (Harrison pp 1704)
Severe (GOLD III)
Major site of increased resistance in most individuals of COPD (Harrison pp 1701)
Small airways (≤ 2mm diameter)
Definitive test for establishing the presence or absence of emphysema in living subjects (Harrison pp 1705)
CT Scan
In stable phase of COPD, only three interventions have demonstrated to influence the natural history of patient with COPD (Harrison pp 1705)
Smoking cessation
O2 therapy
Lung volume reduction surgery
Alternative treatment for smoking cessation (Harrison pp 1705)
Nicotine replacement therapy
Bupropion
Varenidine
Long acting anticholinergic that have shown for improvement symptoms and reduce exacerbations (Harrison pp 1705)
Tiotropium
It produces modest improvements in expiratory flow rates and vital capacity (Harrison pp 1706)
Theophylline
It is the only pharmacologic therapy demonstrated to unequivocally decrease mortality rates in patient with COPD (Harrison pp 1706)
Supplemental Oxygen
COPD patients should receive the influenza vaccine annually (Harrison pp 1706)
True or False
True
It has demonstrated to improve health-related quality of life, dyspnea and exercise capacity
Reduce rates of hospitalization over 6 to 12 months period (Harrison pp 1706)
Pulmonary rehabilitation
Contraindicated for lung volume reduction surgery (Harrison pp 1706)
Pleural disease Pulmonary artery systolic pressure >45 mmHg Extreme deconditioning Congestive Heart Failure FEV1 < 20% Diffusely distributed emphysema
What is the strong predictor of future exacerbations? (Harrison pp 1706)
History of prior exacerbations
Bacterial associated with COPD (Harrison pp 1707)
Haemophilus influenzae
Moraxella catarrhalis
Streptococcus pneumoniae
